
Class _H20~4J 
Book__ 







GofpghtN - 



COPYRIGHT DEPOSIT. 



The Parent's Library 

Nine Volumes, Uniformly Bound. 12 mo. 
Cloth. Per Volume, $1.50 



First Steps in Child Training 

By PROFESSOR M. V. O'SHEA 

The Trend of the Teens 
By PROFESSOR M. V. O'SHEA 

Faults of Childhood and Youth' 
By PROFESSOR M. V. O'SHEA 

Everyday Problems in Child Training 

By PROFESSOR M. V. O'SHEA 

Putting Young America in Tune 

How to Teach the Child Appreciation 

of Music 

By HENRIETTE WEBER 

The Home Guide to Good Reading 

With Notes 

By PROFESSOR DAVID HARRISON 
STEVENS 

The Proper Feeding of Infants 
By W. H. GALLAND, M. D. 

Diseases of Infancy and Childhood 

By W. H. GALLAND, M. D. 

Maternity and Child Care 

The Iiives- of Mothers and Children, 

How We Can Save Them 

By W. H, GALLAND, M. D. 




The Foundation of Society 



£be Rarent'g Xibrarg 

Maternity and Child 
Care 



' jX BY 

w/h. gall and, m. d. 

Medical Director 
Mother's Magazine and Home Life 



CHICAGO 

FREDERICK J. DRAKE & CO. 

Publishers 






Copyright, 1920 

By Frederick J. Drake & Co., 

Chicago 



All Rights Reserved 



©CI.A604316 



m * 23 1920 



-. 

hi 



£be parent's Xtbrars 

A series of practical books relating to the care and culture 
of the young, published under the editorial supervision of 
Professor M. V. O'Shea of the University of Wisconsin, Edu- 
cational Director, and Mr. Paul E. Watson, Editorial Direc- 
tor, of Mother's Magazine and Home Life, in cooperation with 
which magazine this Library has been prepared. 



PREFACE 

Prevention is our watchword of today. To 
stamp out disease, we must prevent it. How? 
With knowledge. Knowledge is the cornerstone 
on which our life-saving stations must be built. 
Superstitions and wrong teachings must be thrust 
away with the discarded ideas of the past, for 
this is a new age of health. 

Our National Conservation Commission reports 
that forty out of every hundred premature births 
can be prevented ; that forty out of every hundred 
cases of congenitally weak babies can be avoided ; 
and that seventy out of every hundred babies 
whose eyes are infected at birth can be saved this 
misfortune. This Commission reports that nearly 
half of the babies who do not survive the first 
year of life die from conditions existing before 
or at the time of their birth and that these con- 
ditions may be prevented if the mother can be 
reached and told what she should know, and what, 
in the vast majority of cases, she is anxious to 
learn. 

Added to these figures of needless waste of 
child-life, are the appalling figures of the thou- 
sands of mothers whose lives are sacrificed 
annually through lack of knowledge and proper 



PREFACE 

care during the time when they are fulfilling their 
highest destiny, that of motherhood. 

Read these figures and you have the reason 
why this book is written. It is written in the 
hope that it may carry the truths that make for 
safe motherhood; carry them in so simple a lan- 
guage that, wherever needed they may be plainly 
understood by every prospective mother. And 
thus, every child of the home into which this book 
goes may receive through its message more of the 
benefits that modern medical science has to offer. 

William Herbert Galland 
Glengary, 
Mount Airy, 
Croton-on-Hudson, 



TABLE OF CONTENTS 

CHAPTER PAGE 

I The Story of Reproduction li 

II The Embryo's Growth and Food 21 

III Signs of Pregnancy 32 

IV Diet in Pregnancy 42 

V Nausea and Vomiting 50 

VI Special Care of the Bowels, Kidneys, 

Skin and Lungs 62 

VII The Care of the Body 71 

VIII The Interruptions of Pregnancy — Mis- 
carriage and Premature Births 82 

IX Maternal Impressions and Eeal Pre- 
natal Influences 89 

X Preparing for Confinement 95 

XI The Birth of the Baby 109 

XII Care During the Puerperium or Period 

After Labor 125 

XIII The Baby's First Days 143 

XIV Accidents to the New Born 160 

XV The Baby's Hygiene 172 

XVI The Baby's Growth 186 

XVII The Formative Years 205 

XVIII Teaching Health to the School Child. . .218 

XIX Diet for the School Child 241 

- XX The Common Ills 257 

Index 279 



MATERNITY AND CHILD CARE 



CHAPTEB I 
THE STORY OF REPRODUCTION 

In telling the story of reproduction, let us first 
consider the anatomy of the organs of reproduc- 
tion and their duties. We have the ovaries, of 
which there are two; the fallopian tubes, also 
two in number; the uterus or womb; and the 
vagina; all situated in the pelvis which is the 
basin-like ring of bone at the lower extremity 
of the trunk supporting the spine and resting on 
the lower limbs. 

The vagina is the canal extending from the 
vulva to the cervix or neck of the uterus. From 
the upper and outer sides of the uterus extend 
the two fallopian tubes, one passing to the right 
and the other to the left like two outstretched 
arms. These tubes are about the size of a lead 
pencil and about four and a half inches long. 
They are covered on the outside with the same 
smooth layer of membrane that covers all of the 
organs of the abdominal cavity. 

11 



12 MATERNITY AND CHILD CARE 

The fallopian tubes are hollow and lined with 
a delicate mucous membrane quite similar to 
that lining the nose and throat. Growing out of 
this lining in a most interesting way are minute, 
vibrant, hair-like processes in constant wave- 
like motion which sweep everything that comes 
into the tubes on into the uterus. The outer 
ends of the tubes flare like little trumpets, but 
where they empty into the uterus they diminish 
to a size that admits the passage of no substance 
larger than a coarse hair. Fine muscles make up 
the walls of these tubes and the purpose of these 
muscles is, when in normal condition, to prevent 
the tubes from collapsing. 

Just about midway, below and behind each 
fallopian tube, are the two ovaries, one on each 
side. Approximately the size of a prune, these 
are the most interesting organs of the human 
b>ody. The ovaries are not at the end of the 
tubes opening directly into them as commonly 
believed, but at the center. Each ovary is held 
to the side of the uterus by a firm short liga- 
ment, and is covered by a smooth thin tissue 
which performs two important duties. 

Within each ovary at the time of birth of the 
girl baby, are many thousands of infinitely tiny 
ova or eggs. It has been estimated that there 
are forty thousand divided about equally between 
the two ovaries. These minute ova begin to 
ripen at the time of puberty and this process 



THE STORY OF REPRODUCTION 13 

continues actively until the menopause or 
"change of life." 

The second great function of the ovaries is 
the manufacture and elaboration of a secretion 
which passes directly into the woman's blood 
and has a controlling influence over menstrua- 
tion and a direct bearing upon the general health. 

The ovum lies within the ovary in a diminu- 
tive sac which is lined with a single layer of 
cells. As the ovum ripens, these cells multiply 
and the fluid contained in the sac increases. This 
structure is called a graafian follicle and as 
the follicle grows, it pushes its way up to the 
outer wall of the ovary until the ovum is entirely 
ripened. Then the follicle bursts through the 
thin walls of the ovary and the ripened ovum is 
thrown upon the smooth lining of the abdominal 
cavity. Through some force not clearly under- 
stood, the ovum travels outward until it reaches 
the end of the fallopian tube and there it is 
caught up by the hair-like processes and swept 
through the tube into the uterus or womb. 

This process undoubtedly takes place just 
before menstruation. In most instances, an ovum 
is probably discharged at one menstrual period 
and another from the other ovary at the fol- 
lowing period. An ovum discharged from each 
ovary at the same time accounts for twin births. 
If three or four ripen at the same time, we have 
the phenomenon of triplets or quadruplets. 



14 MATERNITY AND CHILD CARE 

The uterus, into which the fallopian tubes 
empty, is pear shaped and about three and one- 
half inches long. The upper or more dilated 
part is known as the fundus; the smaller end 
where it diminishes into the neck, emptying into 
the vagina, is called the cervix. 

The outer surface of the uterus is composed 
of the same smooth membrane which covers the 
other organs. The walls are made up of power- 
ful muscles, and the inner lining is a delicate 
and smooth mucous membrane called the endo- 
metrium. This inner membrane, like the lining 
of the fallopian tubes, is covered with the deli- 
cate, vibrating hair-like processes which have a 
constant waving motion downward and outward 
toward the vagina. If the ovum fails to become 
impregnated or fertilized it is this motion that 
sweeps it out of the uterus into the vagina. 

The uterus is suspended in the pelvis by strong 
ligaments. The body or the fundis is held for- 
ward so that the neck or mouth of the womb 
points backward to the posterior wall of the 
vagina the upper -end of which closes around the 
neck of the womb. Just below the mouth of the 
womb in the upper posterior wall of the vagina 
is a cup-like depression where the spermatozoa 
are deposited and where they may remain for 
some time, ready to gain entrance to the mouth 
of the uterus. 

From the standpoint of anatomy and physi- 



THE STORY OF REPRODUCTION 15 

ology, there are many causes of sterility. The 
ovum may not ripen properly, or the covering 
of the ovary may become so firm and thickened 
from inflammation that the graafian follicle can- 
not burst through, with the result that the ova 
are held imprisoned beneath the covering of the 
ovaries and form little cysts. Again, an inflam- 
mation in the pelvis may be so severe as 'to 
completely close the outer ends of the fallopian 
tubes so that the ripened ova cannot gain 
entrance to the uterus. Acute inflammation of 
the pelvis may produce adhesions which kink or 
twist the tubes, doubling up and completely clos- 
ing them so that the progress of the ova through 
the tubes is checked. Diseases or inflammations 
which roughen the smooth lining of the uterus 
itself may cause sterility, this being quite com- 
mon. Tumors growing in the walls of the uterus 
and making them irregular and rough are fre- 
quent causes of sterility. 

The lining of the body of the womb constantly 
secretes a watery substance, just as does the 
mucous membrane of the mouth. This keeps 
the lining of the womb moist. The lining of the 
lower part or mouth of the womb throws off a 
heavier, more viscid secretion. At times this 
may become very acid, as in certain types of 
leucorrhoea, and this acidity may be the means 
of rendering the spermatozoan inactive, resulting 
in sterility. 



16 MATERNITY AND CHILD CARE 

MENSTRUATION" 

Just before the time for menstruation, the 
membrane lining the uterus grows thicker. This 
is brought about by a secretion of the ovaries 
which is thrown into the mother's blood and has 
a direct action on the uterus. The lining mem- 
brane swells if it becomes fertilized in order to 
make a soft nest for the ovum and its blood 
vessels become gorged. If the ovum is ferti- 
lized it imbeds itself upon this lining and throws 
out a secretion which prevents menstruation. If 
the ovum fails to becomes fertilized all the tiny 
engorged blood vessels break, bleeding occurs, 
the congestion is relieved and the membrane 
returns to normal. This is the process of men- 
struation. 

When each menstruation period is passed there 
are a few days of rest and then the membrane 
again begins to slowly thicken and prepare itself 
for the next possibility of impregnation. The 
secretion from the ovaries not only acts upon the 
uterus but upon the entire system. It first pro- 
duces a congestion of all the mucous membranes 
of the body, those lining the nose and throat and 
stomach also becoming thickened like the lining 
of the uterus. Some women are made irritable, 
cross, nervous and restless; some, on the other 
hand, are made depressed, listless and sleepy. 
Many notice a fullness of the breasts, with the 
same sensation in the pelvis; of times with pain 



THE STORY OF REPRODUCTION 17 

in the back which radiates down the limbs. For- 
tunately there are many women who go through 
life with little or no discomfort. 

Painful Menstruation. — The pain may become 
severe either before this period, during menstru- 
ation, or directly afterward. Constantly, the 
womb keeps up a gentle contraction and expan- 
sion and this provides exercise for the muscles. 
^When the opening of the womb is very small 
and if clots of blood form in the uterus, the 
effort of expelling them at the time of men- 
struation causes pain. 

Another cause of painful menstruation is a 
displacement of the pelvic organs. From child- 
birth, or from the strain of constant heavy lift- 
ing or from a fall, the ligaments which support 
the pelvic organs become relaxed, allow the 
uterus to fall downward and tip backward, and 
thus cause a drag upon the wonderful and intri- 
cate plexus of nerves in the pelvis. 

The functions of menstruation, of child-bear- 
ing and recovery after labor, and of nursing, 
are all a supreme tax upon the general physical 
health of the woman. Too much rest and care 
cannot be given at these critical times. 

IMPREGNATION 

In the ovum is a tiny vital spot which is the 
nucleus, the spark of life. It is surrounded by 
a yolk which is its food. 



18 MATERNITY AND CHILD CARE 

The spermatic fluid of the male contains num- 
berless tiny cells, each having a minute vital 
spot or nucleus. Attached to the nucleus is a 
slender hair-like process in constant wavelike 
motion which keeps the male cells steadily sweep- 
ing forward. This movement is so active that 
the male cells are driven upward over the lin- 
ing of the womb, even against and beyond the 
small waving cilia which cover the lining and 
which are constantly sweeping downward what- 
ever comes in their path. The male cells travel 
through the tubes and lie in wait for the ovum. 

Like the ovum, the vital male cell soon dies if 
left alone. It is very delicate and at the time 
of cohabitation is deposited in the pouch in the 
vagina at the mouth of the womb. 

When the tiny male cells at last enter the fal- 
lopian tubes to wait for the ovum, they may live 
for many days. They possess some strange 
power of attraction for each other and quickly 
fuse; the tiny, vital male element directly pene- 
trating the female ovum. The fine, tail-like proc- 
ess is lost and the moment this union takes place 
rapid growth begins. 

From the union of the female with the male 
nucleus there develops one live cell, which quickly 
divides into two, four, and eight, and so on at 
a tremendous rate into thousands of cells which 
form a shell or covering to surround the fetus 
during its growth in the uterus. These cells 



THE STORY OF REPRODUCTION 19 

arrange themselves into groups within this cover- 
ing, they take on special functions and finally 
form the organs of the newly developing body. 

Just as soon as the female and the male vital 
elements have joined and started their growth, 
the hair-like processes lining the fallopian tubes 
sweep this united cell into the uterus whose lin- 
ing membrane has been preparing to receive the 
impregnated or fertilized ovum. Barely, the 
ovum is caught inside the tube before it can 
reach the uterus, and there starts to grow, pro- 
ducing what is known as a tubal, or an ectopic 
pregnancy. 

When the impregnated ovum reaches the uterus 
under normal conditions, the fertile ovum settles 
into the soft swollen lining and menstruation 
does not occur. But if the ovum fails to become 
fertilized it is swept out of the uterus, the tiny 
engorged blood vessels rupture, menstruation 
occurs and the swollen membrane is relieved of 
its congestion. 

Many things can happen to prevent even the 
fertilized ovum from finding a suitable home in 
the lining of the womb. Either tumors or chronic 
inflammations may so roughen the surface that 
the ovum cannot attach itself to the membrane. 
Again, it may arrive in the uterus before the 
lining is prepared and consequently fail to find 
ready the right place in which to grow. It may 
become loosened from its attachment and some- 



20 MATEHSIITY AND CHILD CARE 

times be immediately thrown off, menstruation 
making its appearance at the usual time and 
carrying it out. Or the ovum may lodge in the 
membrane for a time and then be detached. This 
explains why menstruation is sometimes delayed 
for several days or for two or three weeks. 



CHAPTER II 
THE EMBRYO'S GROWTH AND FOOD 

The fertilized ovum attaches itself to the swol- 
len lining of the uterus by a remarkable proc- 
ess. The covering formed by the cells is well 
started by the time the ovum reaches the uterus. 
It secretes a substance which destroys or absorbs 
some of the cells in the lining of the uterus at 
one small spot. This forms a nest in which the 
ovum burrows. The rest of the lining grows 
gradually thicker and richer in blood vessels 
and actually grows over the ovum in its nest. 
This new, thickened membrane we call the 
decidua. In addition to the secretion which we 
have just mentioned the ovum throws out another 
secretion which prevents menstruation from 
occuring and washing out this new life. 

Eight at the spot where the ovum attaches 
itself to the lining of the uterus, there develops 
that important membrane, the placenta, through 
which the embryo breathes and receives its food 
until birth. 

The outer covering or shell for the embryo 
begins to develop as soon as impregnation occurs 
and the cells making up this covering grow so 

21 



22 MATERNITY AND CHILD CARE 

rapidly that the embryo is very shortly entirely 
surrounded by two complete layers or mem- 
branes. The outer layer is the chorion ; the inner 
layer, the amnion. The sac itself, made up of 
these two layers in which the tiny embryo is 
rapidly developing, is filled with a watery secre- 
tion called the amniotic fluid. This rapidly 
increases in amount as the sac grows, and forms 
what is known as "the bag of waters" at the 
time of birth. 

This fluid serves four purposes: it forms a 
cushion of water around the fetus which pro- 
tects it from injury through any jar or blow to 
the abdomen; through pressure from tight cor- 
sets or clothing; or through sudden changes of 
temperature, and it forms the "bag of waters " 
which is so important in dilating the mouth of 
the womb at the time of labor. 

Now let us again turn attention to the outer 
envelope or the chorion. The cells which make up 
this layer begin to grow outward, projecting 
like fingers or the branches of a tree. There are 
thousands of these processes, called villi, and 
just where the little embryo has sunk into the 
lining of the uterus, they develop in great num- 
bers and grow to greater length and size than 
the villi covering the rest of the sac. They 
extend right through the blood vessel walls of the 
membrane lining the uterus and are thus bathed 
in the mother's blood. This is the way in which 



THE EMBRYO'S GROWTH AND FOOD 



23 




Cross Section of Pregnant Uterus 
{After Allen Thompson) 
This Diagram Shows the Relations of the Uterus, the Embryo, 
and the Embryonic Structures at the Second Month of 
Gestation. 1 — Wall of uterus. 2 — Beginning of fal- 
lopian tube. 3 — Placenta showing branches of villi. 
4 — Umbilical cord. 5 — Fetus. 6 — Amnionic 
fluid or "bag of waters." 7 — Amnionic 
membrane. 8 — Chorionic membrance. 
9 — Cervix or mouth of uterus. 



24 MATERNITY AND CHILD CARE 

the "mother cake," the placenta or "after-birth" 
as it is also called, is formed. 

At this point within the sac the embryo is 
growing and becomes attached to the placenta 
by a tiny tubular membrane which becomes the 
navel cord. This navel or umbilical cord enters 
the body of the fetus at the center of the abdo- 
men. Blood vessels are later formed within this 
cord, one of which carries the blood from the 
placenta to the fetus and two of which carry 
the blood from the fetus to the placenta. Before 
the blood vessels form, the embryo absorbs nour- 
ishment directly from the placenta. 

You can readily see from the accompanying 
illustration just how the embryo lies within its 
sac suspended by the umbilical cord and sur- 
rounded by the amniotic fluid. You will notice 
that the sac at one point has grown solidly into 
the wall of the uterus connected by the villi or 
branches of the placenta. The sac hangs in the 
cavity of the uterus and grows with great rap- 
idity, the water constantly increasing until by 
the third month the sac completely fills the 
uterus, becoming attached to the lining mem- 
brane on all sides. 

During this time the fetus and the entire womb 
have steadily grown larger. Until the entire 
lining of the uterus is covered by the sac, some 
blood may make its appearance at the regular 
menstrual periods. This is rare, however, as 



THE EMBRYO'S GROWTH AND FOOD 25 

menstruation normally ceases entirely when preg- 
nancy occurs. 

Any bleeding that may be noticed after the 
third month probably comes from the place where 
the placenta is attached and must be heeded. It 
may mean that contractions of the uterus have 
slightly loosened the placenta and there is pos- 
sible danger of miscarriage. 

Of the blood vessels which develop in the 
umbilical cord, two are veins and one an artery. 
These pass directly from the placenta to the 
body of the fetus, entering at the navel. The 
circulation of blood begins as soon as the heart 
in the developing fetus starts to beat. These 
heart beats can be heard as early as the fourth 
month, but it must be remembered that actual 
life in the embryo begins at the time of con- 
ception. 

The villi are covered by a thin flat layer of 
cells and these cells separate the mother's blood 
from the blood of the placenta, and through them 
the food and oxygen needed by the fetus for 
life and growth are filtered. Thus, the blood of 
the mother does not flow directly into the blood 
of the fetus, or the blood of the fetus into that 
of the mother. After the food and oxygen in the 
mother's blood has been filtered through those 
cells and have been taken up by the blood of the 
placenta, they are collected in those converging 
blood vessels at one point, emptied into the 
artery in the umbilical cord, carried to the arter- 



26 MATERNITY AND CHILD CARE 

ies which have formed in the fetus and thence 
circulated by the pumping of the fetus heart to 
all the organs. 

With growth of any kind there is waste mat- 
ter. After the baby is born it gets rid of 
this waste through the lungs, kidneys, bowels 
and skin. While the fetus is growing in the 
uterus this waste is collected into the baby's 
veins and these veins, converging, empty into 
the two veins of the umbilical cord. Thus the 
waste is carried out through the placenta to the 
villi where it seeps back into the mother's blood 
through the same cells, just as the nourishment 
was filtered in. 

The placenta also takes the place of lungs as 
no air is received into the baby's lungs until 
birth. 

The waste is gotten rid of through the mother's 
skin and lungs and bowels but mostly through 
the kidneys. Remember this as it explains why 
so much attention must be given to the kidneys 
during pregnancy. 

It is difficult for the mother to transmit actual 
disease to the baby in her uterus, because no solid 
substance can pass through the layer of cells 
which separate the blood of the fetus from that 
of the mother. Bacteria circulating in the 
mother's blood, such as the germs of tubercu- 
losis and typhoid fever, cannot pass through 
these cells so long as they remain intact. 



THE EMBRYO'S GROWTH AND FOOD 27 

GROWTH 

Now that we have learned the way in which 
the ovum starts its growth, how it is protected 
and nourished, let us determine how it takes its 
shape and the rate of its development. 

During the first six weeks of its life the fer- 
tilized ovum is known as the embryo. At the 
end of the fourth week, the embryo is about the 
size of a pigeon's egg; at the end of the second 
month it is the size of a hen's egg and human 
shape can be discerned without the aid of a 
magnifying glass if the embryo is expelled at 
this time. At the twelfth week the embryo is 
slightly larger than a goose egg and the sex can 
be distinguished. 

After the sixth week it is proper to drop the 
term embryo ancl name the developing life, the 
fetus. After the twentieth week growth is very 
rapid. The rate is the same in all mothers regard- 
less of physical characteristics. 

APPROXIMATE GROWTH OF FETUS 



mths 


Length in 


Weight in 




Inches 


Pounds 


7 


15 to 17 


3V> to 4 


8 


16 y 2 to 19 


3% to 5% 


9 


19 to 21 


6V 2 to 8 



The first baby is usually smaller than subse- 
quent children. The average birth weight 
approximates seven pounds and three ounces. 



28 MATERNITY AND CHILD CARE 

but full term babies commonly range in weight 
from six to ten pounds. Exceptional cases are 
reported where babies have weighed more and 
even less than these figures. 

The mother who is overworked and poorly 
nourished is very liable to have a baby whose 
N weight is below the average. This is also true 
of small women. The mother who exercises little 
and eats heartily is prone to have a baby 
weighing eight or nine pounds or even more. 

Throughout pregnancy the uterus keeps up the 
gentle contraction and expansion and while this 
is mild it is sufficient exercise to keep up the 
strength and tone of the muscles, which quali- 
ties are so necessary at the time of labor. As 
the uterus enlarges it rises slowly out of the 
pelvis and by the fourth month it can be felt 
just above the pelvic bones. At about the middle 
of the fourth month or a little later, the woman 
pregnant for the first time, feels life. Often- 
times this first movement is not recognized. 
When it is noticed the mother describes it as a 
slight fluttering and it becomes more pronounced 
until the "little kicks " can be felt and seen 
against the side of the abdomen. In a second or 
later pregnancy life is usually recognized earlier 
than in the first pregnancy. 

By the fifth month the physician's practiced 
ear can hear the heart beat faintly and this is 



THE EMBRYO'S GROWTH AND FOOD 29 

very distinct by the sixth month. The heart 
of the fetus beats about twice as fast as that 
of the mother. 

By the fifth month the uterus has risen up 
halfway between the pelvic bones and the navel ; 
by the seventh month it is three or four fingers 
above the navel; and by the eighth month it has 
risen as high as the cartilage at the end of the 
breast-bone. The last two weeks of pregnancy 
the uterus begins to sink. This movement is 
described by the mother as ' ' settling. ' 9 

When the full term has been reached the uterus 
has assumed the shape of an immense egg. The 
walls of the sack containing the baby are attached 
to the entire lining of the uterus except at one 
point directly over the mouth of the uterus where 
the sac is simply stretched across. At the place 
where the ovum first nested itself, the lining 
has become greatly thickened. Here is attached 
the placenta which has grown to the circumfer- 
ence of a dinner plate and about an inch in 
thickness. It is about one-sixth of the weight of 
the baby. 

The sac in which the baby floats is now fully 
distended with the amniotic fluid or "bag of 
waters.' J The umbilical cord is now about 
twenty-four inches long. The fetus is usually 
found lying with the head down, and flexed so 
that the chin touches the chest. The back is bent 



30 MATERNITY AND CHILD CARE 

forward, the arms are crossed just below the 
chin, the knees doubled up in front of the abdo- 
men, and in this position the fetus is ready to 
be delivered. 

SEX 

Nothing can be done to influence sex, nor is 
there any way of telling the sex, before the baby 
is born. The theory has been advanced that the 
rate of the heart-beat is a determining factor, 
but this is in no way reliable. The most plaus- 
ible theory is that the male element is the deter- 
mining factor. It is maintained that part of the 
male cells contain the female germ plasm and 
part the male germ plasm, these cells being 
equally divided in the male generative organs. 
Based upon this theory the births of males and 
females would be equal. Statistics bear this out 
with a slight variation. 

TWINS 

In approximately one out of every ninety preg- 
nancies, twins occur. Heredity seems to have 
a decided influence in the birth of twins. Rec- 
ords show that twins appear in the same family 
for several generations. We have traced twt> 
causes for twin births. One is the case of two 
ova being impregnated at the same time by two 
different male elements, and by this double fer- 
tilization we may get twins of both sexes, a 



THE EMBRYO'S GROWTH AND FOOD 31 

boy and a girl born at the same time. The other 
case is of the single fertilized ovum that divides 
into two separate groups of cells, giving us twins 
of the same sex closely resembling each other. 



A 



CHAPTER III 
SIGNS OP PREGNANCY 

Pregnancy is a perfectly normal condition and 
there is no occasion for alarm or apprehension 
when the first signs make their appearance. The 
first and most important thing to be done is to 
place yourself at once in the care of your phy- 
sician. This is because the troubles that develop 
during pregnancy and at the time of confine- 
ment have, as a rule, very small and many of 
them early beginnings. So slight are the begin- 
nings of these troubles that only the practiced 
eye of the physician can detect them at the start. 
He can set about their immediate correction. 

The early signs of pregnancy are known to 
nearly every woman and she can usually tell 
when she is pregnant before seeking the advice 
or examination of her physician. Mistakes are 
many times made, however, because signs which 
are associated with pregnancy and are usually 
considered infallible may be the indications of 
other conditions entirely foreign to this. 

The first group of signs can only be called 
probable or presumptive signs. The second 
group is made up of the positive signs and do 

32 



SIGNS OF PREGNANCY 33 

not make their appearance until after the first 
signs. 

Of the probable signs there are four: the ces- 
sation of menstruation, the changes in the 
breasts, morning sickness and the frequent or 
painful urination. 

The stopping of menstruation is always the 
first symptom of pregnancy to attract attention 
if it happens during the child-bearing period. 
There are other conditions, however, which are 
in no way associated with pregnancy which may 
cause temporary cessation of menstruation. 
While pregnancy may occur at any time during 
the month, it more often takes place just before 
or just after the menstrual period. 

The conditions which cause menstruation to 
cease temporarily are most often known to a 
woman and she is not apt to confuse them with 
a sign of pregnancy. 

The change of life, or menopause, usually 
begins with irregularity of the monthly periods. 
This is quite frequently mistaken for a sign of 
pregnancy, but rarely does pregnancy occur at 
this time. Any acute or chronic disease of the 
ovaries or womb may suppress menstruation for 
an indefinite period. When an operation is per- 
formed for the removal of both ovaries men- 
struation permanently ceases. This does not 
follow the removal of one ovary. 

Anaemia, the condition in which the blood 



34 MATERNITY AND CHILD CARE 

becomes thin or impoverished, will produce irreg- 
ular and scanty menstruation and oftentimes 
cause it to cease temporarily. Great anxiety, 
serious shock, worry, or severe physical or mental 
strain may cause menstruation to cease for a 
time. 

The nursing mother, in whom menstruation 
has not become re-established, thus becomes 
pregnant at times without being aware of it. 
She has neither the sign of cessation of the 
monthly periods nor the change in the breasts 
to be guided by. 

You readily see the importance of consulting 
your physician at the first probable signs of 
pregnancy, as the cessation of menstruation due 
to any of these other conditions demands his 
advice and attention. 

A slight bleeding may sometimes occur at the 
regular menstruation periods for two or even 
three months after pregnancy, but this is much 
less in amount and of short duration. Any con- 
siderable loss of blood that appears after preg- 
nancy has been determined indicates a threat- 
ened abortion, or miscarriage, which is especially 
liable to happen at the menstrual period, and 
should be immediately brought to the physician's 
attention. 

Changes in the Breasts. — Many sensations may 
occur in the breasts early in pregnancy. These 
include the sense of fullness ; extreme tenderness, 



SIGNS OF PREGNANCY 35 

so marked sometimes that no pressure may be 
bourne over them. They also include throbbing 
and tingling; and by the second month the nip- 
ples increase in size and stand out more promi- 
nently; the circular area around the nipples grow 
darker in color. This color is much deeper 
in brunettes. At the base of the nipples are 
tiny glands which begin to enlarge and can be 
seen standing out just underneath the skin. By 
the fourth month a white watery substance 
which is known as colostrum, can be seen if the 
nipples are gently compressed. In the later 
months this turns to a yellowish color and is less 
watery. This is not milk and it disappears the 
third or fourth day after the baby is born. 

The woman who has recently nursed a baby 
may find some milk secreted in the breasts for 
quite a time after weaning and this is not an 
indication of another pregnancy. 

Morning Sickness. — Soon after the first men- 
struation is missed morning sickness usually 
makes its appearance. It is generally most pro- 
nounced soon after rising and in most instances 
passes away after the third month. This sick- 
ness may amount in some women only to a slight 
nausea, and in others be so serious that actual 
vomiting takes place. It may pass away in one 
or two hours, or it may persist for half a day 
and in rare cases last throughout the day. 

Severe and persistent nausea and vomiting 



36 MATERNITY AND CHILD CARE 

must not be ignored, as they often point to an 
accumulation of poisons in the system which 
must at once be brought to the physician's atten- 
tion. 

Disturbances of Urination. — Pregnancy usually 
causes frequent urination often accompanied by 
some pain and difficulty in passing the urine. 
This is simply due to the pressure of the enlarg- 
ing uterus upon the bladder. By the fourth 
month the uterus has risen so high that the pres- 
sure on the bladder is relieved and these dis- 
turbances disappear. In the latter weeks of 
pregnancy, when settling occurs, these symptoms 
may again return as the uterus again presses 
against the bladder. 

Because of the frequency of urination, the 
prospective mother must not cease drinking 
plenty of liquids, as the extra supply of water 
and other liquids is absolutely essential to her 
health and that of the baby's throughout the 
entire period of gestation. 

The Positive Signs. — The first positive sign 
of pregnancy is determined by your physician's 
examination. It is the enlargement of the uterus. 
The pregnant uterus enlarges in a characteristic 
way, quite different from the enlargement due 
to other causes such as tumors. The first posi- 
tive sign noticed by the mother is movement, or 
as it is commonly called, "quickening." This 
comes some time between the eighteenth and 



SIGNS OF PREGNANCY 37 

twenty-first week. This comes as a fluttering 
sensation or as gentle taps and grows stronger 
as the time progresses, usually being most notice- 
able at night. It is even so pronounced at times 
as to interfere with sleep and later the taps 
or " kicks ? * as they are called can be plainly seen 
against the abdominal wall. When movement 
has become established and then a period occurs 
in which no movement is felt for two or three 
weeks you must not fail to call this to your 
physician's attention. 

The next positive sign of pregnancy is the 
fetal heart-beat. This your physician can hear 
through the walls of your abdomen by the latter 
part of the fourth month or early in the fifth. 
The heart-beat is 150 to 160 a minute or about 
twice that of the mother. This is a most valu- 
able sign because where the baby has been quiet 
for some time, movement not being noticed by 
the mother, the physician can reassure the 
mother that everything is all right by listening 
to the fetal heart-beat through his stethoscope 
or by placing his ear against the abdomen. 

THE DATE OF CONFINEMENT 

If the positive date of conception were known, 
the time of confinement could be estimated to 
take place 275 days from that date, or in approx- 
imately thirty-nine weeks. However, the date of 
conception is rarely known, therefore, the method 



38 MATERNITY AND CHILD CARE 

of calculation is to estimate the time from the last 
menstruation. Experience has led us to count two 
hundred and eighty days from the first day 
of the last menstruation as the average period 
of pregnancy up to the date of confinement. 
This corresponds to the nine calendar months, 
the time commonly referred to which comprises 
ten lunar or menstrual months of 28 days each. 

Rarely does delivery occur before the esti- 
mated time. If you count forward two hundred 
and eighty days from the first day of the last 
menstruation, you are as near as you can come 
to the approximate date of your confinement. 
Another simple method of calculating this date 
is to count backward three months from the first 
day of the last menstruation, and then add seven 
days. This gives exactly the same number of 
days. This estimate is based on the assumption 
that pregnancy occurred right after menstru- 
ation, which is most usual, but pregnancy may 
have occurred later in the month so that the 
estimate would vary several days. 

If the date of the last menstruation is not 
known the only method of calculation is to esti- 
mate from the day the first movement or "quick- 
ening' 9 is felt. As this usually occurs about the 
eighteenth week we add to this time twenty-two 
weeks. This is not nearly so accurate, for quick- 
ening may not be felt until later than the 
eighteenth week. If the date of the first move- 



SIGNS OF PREGNANCY 39 

ment is not known the only method left is the 
very inaccurate one of estimating the number of 
months of pregnancy by examining the size of 
the womb. 

Second pregnancies are, as a rule, a few days 
longer than the first. Delicate and sickly women 
and women who overwork are liable to be con- 
fined a few days before the estimated time. 
Women who are inactive are very prone to go 
over the estimated date. The sex of the child 
has no influence upon the date of confinement. 
Twins are liable to be born before the calculated 
date. 

The mother who has made the estimation of 
two hundred and eighty days should not worry 
if she goes one or two weeks over this time, but 
if she passes the third week her physician will 
induce labor if he is reasonably sure that she 
has not miscalculated the time. 

PREGNANCY IN THE FALLOPIAN TUBE 

In very rare cases the impregnated ovum may 
be caught in the fallopian tube before being 
swept into the uterus, and, attaching itself to the 
wall of the tube, may begin to grow. The open- 
ing in the fallopian tube is very small and with 
the growing ovum serious trouble results. The 
ovum may be violently detached by the natural 
contraction of the muscles in the tube and thrown 
off completely before it has attained much size. 



40 MATERNITY AND CHILD CARE 

A comparatively small amount of bleeding occurs 
in this case. Again, the little villi may grow 
right through the wall of the tube and slow 
bleeding occur around the tube outside of the 
womb. The embryo may also grow and fill the 
tube until it actually bursts through, producing 
sudden severe hemorrhage with shock and col- 
lapse. 

A woman who has such a tubal or ectopic 
pregnancy usually passes her menstruation 
period, although frequently a slight bleeding 
occurs at the regular time and lasts for a few 
hours. Commonly the menstruation period is 
several days late and then the bleeding is also 
very slight, but this is usually accompanied by 
considerable pain in the right or left side, 
depending upon which tube the pregnancy has 
taken place in. The small amount of bleeding 
from the uterus may come at irregular intervals, 
several days of cessation and then slight bleeding 
again. The pain in the side increases at these 
times of bleeding, becoming severe in the nature 
of a colic. Women often think this is a threat- 
ened miscarriage. Whenever these suspicious 
symptoms occur you should notify your physi- 
cian without fail and at once. 

Following suspicious symptoms of this descrip- 
tion if there develops a sudden sharp pain fol- 
lowed by great faintness, dizziness and collapse, 
not a moment should be lost in getting into imme- 



SIGNS OF PREGNANCY 41 

diate communication with a competent surgeon 
as an instant operation is necessary. 

It is a strange fact and one that must be 
carefully noted that after a pregnancy has once 
occurred in the tube, normal pregnancy may 
later occur again, but there is great danger of 
a second pregnancy occurring in the other tube. 
For this reason physicians emphasize the impor- 
tance of avoiding pregnancy for at least two 
years after the tubal or ectopic pregnancy has 
taken place. 

Women with tubal pregnancies rarely experi- 
ence morning sickness, there is practically never 
any change in the breasts, and the womb does 
not enlarge. 



CHAPTER IV 
DIET IN PREGNANCY 

The Expectant Mother's Weight. — In the early 
months of pregnancy the mother's weight 
remains about the same. Sometimes there is a 
slight loss, sometimes a little gain. But in the 
last three months there is an average monthly 
gain of three and a half to five and a half 
pounds. At birth there is the natural loss to 
the mother of ten to fifteen pounds, and a little 
later the tissues which have been stimulated by 
pregnancy return to their normal condition and 
there is a further loss of weight. However, after 
a normal confinement, most mothers remain a 
little heavier and generally better nourished than 
they were before pregnancy. 

Thus, the mother does not require extra food 
for the child's growth until the sixth month. 

The Use of Her Foods. — The body is con- 
stantly calling for the carbohydrates and fats 
to supply body fuel and yield heat and energy. 
The carbohydrates are starch and sugar, and 
we are all familiar with the common foods that 
we must provide to give the needed supply of 
fats, sugar and of starch, which is turned into 

42 



DIET IN PREGNANCY 43 

sugar in the process of digestion. Besides the 
cane sugar which is our regular table sugar we 
get sugar in grapes and other fruits, in corn, in 
onions and in other vegetables. Fat we get in 
abundance in cream and butter, cocoa and choco- 
late, and the fatty meats. 

Again the body is continually calling for the 
protein element in our food. We get our animal 
protein in meat, milk, eggs and cheese. If we 
eat too little protein food our tissue-building 
suffers. If we eat too much meat, which is our 
principal protein food, there is increased putre- 
faction in the intestines and extra work for the 
kidneys which are the organs most occupied 
with ridding our bodies of the waste products 
of protein. Many people supply the protein 
needs of the body by a purely vegetarian diet, 
but the majority have found a mixed diet of 
both animal and vegetable protein most ad- 
vantageous. 

The other constant call of the body is for 
water and mineral material. Two or three quarts 
of water is being used in the daily process of liv- 
ing. This loss must be supplied by the water in 
our foods and principally by the water we drink. 
Except for our table salt, the mineral material 
which, with the water, assists in building new 
tissue and repairing worn-out tissue, is pro- 
vided in' the other food-stuffs. For example; 
we get iron (which is so essential to the blood) 



44 MATERNITY AND CHILD CARE 

from apples, spinach, lettuce, potatoes, peas, 
carrots and meats. We get lime (the material 
that makes the bones hard), in bread, milk, 
eggs and vegetables. Other mineral constituents 
of the body, such as magnesium, potassium, sul- 
phur and phosphorus, occur in other foods. 

The Needed Extra Food. — After the fifth or 
sixth month there comes a demand for more 
of the heat and energy-giving and the tissue- 
building food-stuffs and one of the best means 
of taking this extra supply is- by drinking milk 
between meals and at bed-time. About a quart 
of rich creamy milk can be taken in this way 
by most mothers. If it tends to cause a little 
indigestion, put a pinch of baking soda in each 
glassful. Some cscnnot take "this extra milk 
and they can supply the needed between-meal 
nourishment by taking a light broth or soup 
with a graham or oatmeal cracker or a cup of 
cocoa. 

The habit of taking milk is so valuable to 
the mother before the baby comes and when she 
is nursing him, that one should try to- cultivate 
it, taking a little at first if it seems distasteful, 
sipping it slowly, and gradually increasing the 
portion. Sometimes a little flavoring of vanilla 
or nut-meg will appease the taste of one who 
tires of milk. In milk there are found all the 
elements of a perfect food and it also helps to 
stimulate the kidneys. Any tendency to con- 



DIET IN PREGNANCY 45 

stipation created by milk can be overcome by 
adding laxative foods to the daily diet, or by 
taking mineral oils at bedtime. 

Three regular meals a day, with the hearty 
one at noon rather than at night, and the regu- 
lar between-meal milk will avoid discomfort and 
sometimes banish all tendency to nausea. 

Additional Liquids. — Very few people ordi- 
narily drink sufficient water so that this is a 
matter that needs special watchfulness during 
pregnancy. For the pregnant woman this supply 
should be more nearly three quarts, the greater 
part of it being water, the rest in milk, soup, 
cocoa or chocolate. There should never be any 
alcoholic drinks and tea and coffee should be 
taken in diminishing amounts so that by the 
fifth month they have disappeared from the 
diet. 

The Laxative Diet. — The additional liquids 
we have just enumerated combined with a 
laxative diet will keep kidneys, bowels and skin 
properly active and will, as a rule, prevent all 
tendency to constipation. Chronic constipation 
is extremely harmful to the child. The slowly 
enlarging organs encroach upon the bowels and 
constipation in the later months becomes more 
difficult to avert. There must be a free, thorough 
movement of the bowels each day, and if the 
laxative diet does not accomplish this it must 
be brought about by an artificial laxative such 



46 MATERNITY AND CHILD CARE 

as a cascara pill at bedtime, or one of the 
mineral oils. 

The laxative diet for pregnancy consists of 
more liquids, more fresh vegetables and more 
fresh fruits and cooked fruits and less meat 
than the amounts taken under ordinary circum- 
stances. Eat meat only once a day, eat it 
sparingly and do not eat it fried. Choose boiled 
and roasted beef and mutton in preference to 
pork and veal. Game, poultry, fish, oysters and 
clams can all be taken by the pregnant woman 
in good health. Pork, goose and duck, being 
high in fat, are not so well digested. Of course, 
as every woman knows, the animal foods to be 
selected before all others are milk and eggs, 
also the products of milk such as cheese, butter 
and buttermilk. 

Of fruits and vegetables that are natural 
laxatives there is an endless variety from which 
to choose to appease the appetite and nourish 
the body. There are apples, peaches, plums, 
grapes, pineapples, cherries, figs, prunes, oranges, 
pears, apricots, grapefruit, raspberries and 
strawberries. In addition to these uncooked 
fruits that belong to the laxative diet, there 
are the cooked and preserved fruits, such as 
pears, apricots, peaches, apples, figs and prunes. 
The fresh green vegetables and the winter 
vegetables have laxative properties. The fresh 
vegetables can be eaten as salads with French 



DIET IN PREGNANCY 47 

dressing of good olive oil or mayonnaise, such 
vegetables include lettuce, water cress, endive, 
celery, spinach, young greens, string and lima 
beans, carrots, asparagus, onions, peas and 
potatoes. Of these spinach is of great value 
as a laxative. Vegetables that should be eaten 
with more care as they are not so digestible are 
raw onions, cabbage, cauliflower, turnips, radishes 
and especially navy beans, which, even thoroughly 
baked, do not make a form of food that is desir- 
able at this time. 

Prominent in the laxative diet of pregnancy 
are the grains. Bread of whole-wheat flour and 
of graham flour is valuable and in the cooler 
weather corn meal also. Oatmeal, at all times 
one of the best growing foods, is a standby 
when thoroughly cooked. Grits are also good. 
These are all nourishing grains. Bran, while 
without food value, is a good "sweep" for the 
stomach and intestines. 

The Cravings of Pregnancy.— -It is my ex- 
perience that there is considerable more fiction 
than truth in anything that I have heard about 
the so-called cravings of pregnant women. If 
the woman who is to be a mother desires one 
article of diet more than another, and it is not 
going to harm her, I would recommend that 
she have it. I know of no case where the child 
has been "marked" by a denial of food that 
was longed for, except by the mark of malnutri- 



48 MATERNITY AND CHILD CARE 

tion in the case of the mother who is not properly 
nourished and provided for. 

The Ideal Diet for the Last Months. — During 
the last four or five months the ideal diet is the 
one that puts the least strain of work on the kid- 
neys and the safest for the mother from every 
standpoint of health. The diet should include 
fresh eggs, buttermilk and sweet milk, cheese, 
fruits of all kinds and vegetables of all kinds 
except navy beans. If the kidneys are not per- 
forming their work properly, you will find the 
advice of all physicians is to entirely eliminate 
meat from the diet, as it readily putrifies in the 
intestines, causing auto-intoxication. You will find 
all authorities agreed that eggs, cheese and espe- 
cially milk, furnish all the animal protein the 
mother needs under such conditions and are 
the ideal animal proteins for the last months 
of pregnancy. For this reason we ask, why add 
meat, to the diet if it is not actually needed, and 
puts extra strain upon the kidneys and increases 
the tendency of the pregnant woman to constipa- 
tion? This diet that I have just set down as ideal 
has proven in my experience by far the safest for 
the expectant mother and is one that supplies 
all the nurishing elements that are needed. 

The Diet's Relation to the Child's size. — 
When the needed food elements are lacking in 
sufficient quantity to provide for both mother 
and child, it seems that in some way the system 



DIET IN PREGNANCY 49 

manages to take from the mother what is needed 
for the child. For instance, where attempts 
have been made to make the baby's bones soft 
by limiting the mother to food deficient in lime 
and other minerals, we have B found that the 
mother's tissues were called upon and drained 
to supply the needed lime for the fetus. Her 
own bones supplied the lime. But when the 
food supply was more than sufficient for both, 
the. excess was distributed and stored up in fat 
in the bodies of both mother and baby. We 
know that women who do not exercise and who 
satisfy abnormal appetites give birth to fat 
babies. Again we find among our very poor; 
premature, small, puny infants born of mothers 
improperly nourished and overworked. Candy, 
cake and other sweets eaten by the mother tend 
to store up fat, but beyond regulating the amount 
of such excess sugar taken into the system, 
the diet should not be tampered with in any 
attempt to reduce the size of the child. 



CHAPTER V 
NAUSEA AND VOMITING 

Nausea, one of the first symptoms of preg- 
nancy, occurs in two-thirds of all pregnant 
women. It is first noticed just after the first 
menstrual period is missed and continues until 
the third month or a little later, ceasing about 
the time life is felt. 

When the embryo starts to grow it throws 
off a secretion in the nature of a ferment which 
circulates in the mother's blood and affects many 
of her organs. One of its most common effects 
is a marked irritation of her nervous system, 
and especially of that part of the brain which 
controls the act of vomiting. On the other 
hand, the mother's blood begins to manufacture 
a substance to counteract this secretion or fer- 
ment. In some mothers this process is rapid 
and quickly overcomes the tendency to nausea, 
in others the process is slow and the vomiting 
and morning sickness are more severe as the 
effects of the ferment are only slightly counter- 
acted. 

Thus, all the excretory organs in the mother, 
the skin, lungs, kidneys and bowels, have a great 

50 



NAUSEA AND VOMITING 51 

amount of work to do. And if, for some reason, 
her blood fails to manufacture the anti-ferment 
to counteract these irritating, poisonous prod- 
ucts, serious disturbances are bound to arise, 
and these troubles we call the toxemias of 
pregnancy. 

When nausea comes before rising, relief will 
be found by taking some such food as a piece 
of toast or two or three oatmeal or salted 
crackers an hour or a half-hour before getting 
out of bed. If dry toast or crackers fail, a 
glass of milk, soft-boiled egg or milk-toast taken 
with a cup of coffee while still in bed, then 
lying still for an hour, will prove successful 
in averting the nausea. Some women become 
nauseated after eating breakfast, vomit all they 
eat but are hungry directly and able to retain 
a second meal. If the sickness is severe it is 
best to lie down and remain quiet for one or 
two hours after eating. This is a good plan 
to follow when nausea comes on during the day. 
Rapid eating and over-eating aggravate this con- 
dition and sometimes it will be better to substi- 
tute four or five lighter meals for the three cus- 
tomary heavier ones. 

When nausea and vomiting becomes so severe 
that the mother is compelled to remain in bed 
for several days and is not even able to retain 
small amounts of food and liquids, the necessary 
amount of nourishment must be given by the rec- 



52 MATERNITY AND CHILD CARE 

turn. This method of feeding is to be carried out 
according to the directions of a physician. 

Whether it will be the dry foods taken with 
small amounts of water at mealtimes and with 
the needed additional water between meals, or 
the liquid and semi-liquid foods at mealtimes 
that will best overcome nausea, can only be 
determined by experimenting. 

The condition of the bowels has a direct in- 
fluence on the condition of nausea. They must 
be kept open, for if constipation is allowed to 
exist for even a few hours, dizziness, nausea 
and headache are prone to result. 

The state of mind has a tremendous influence 
upon the prevention of nausea. If the mind 
can be diverted from an apprehension or expec- 
tation of nausea, many cases can be greatly 
relieved and controlled. Worry of any kind; 
fear, anger, or shock, not only aggravate this 
condition but actually will bring it on. 

There are numberless preparations which have 
been commonly recommended for the relief of 
nausea and vomiting, but experience has shown 
that what might possibly relieve one mother 
would be entirely ineffectual with another. Any 
such medicine had best be prescribed by your 
physician to meet the individual needs of your 
case. 

Persistent Vomiting Due to the Poisoning of 
the System. — There is always a definite cause 



NAUSEA AND VOMITING 53 

within the body itself if vomiting and nausea 
persist. The morning sickness of the first three 
months of pregnancy is not necessarily a sign 
of any serious trouble, but if it continues after 
the third month and is severe, it is an unmis- 
takable signal of the piling up of poisons in 
the system. This points strongly to a failure 
of the kidneys to do their proper work and to 
the existence of a condition known medically as 
the toxemia of pregnancy. 

While it is true that many of these poisons or 
toxemias which accumulate in the mother's blood 
are the waste products thrown off by the grow- 
ing fetus, we must not lose sight of the fact 
that many of them come from the mother's own 
intestines where constipation and auto-intoxi- 
cation, or the decomposition of food, are allowed 
to exist. Auto-intoxication commonly follows 
the diet of improper food, especially when too 
largely made up of animal protein in the form 
of meat. 

To prevent the accumulation of poisons in her 
system the mother must give constant atten- 
tion to her personal hygiene. She must keep 
every channel through which poisons are gotten 
rid of actively at work. It is almost beyond 
belief to find what can be accomplished by strict 
observance of these details. 

Clothing of sufficient warmth must be worn to 
prevent the skin from chilling because in the 



54 MATERNITY AND CHILD CARE 

chilled skin the mouths of the sweat glands are 
contracted and fail to throw off their poisons 
properly. It is the daily warm bath with brisk 
rubbing that keeps the skin glands active and 
removes the poisons thrown out, which if allowed 
to remain will clog the pores. It is the proper 
amount of daily exercise that keeps all the 
organs of the body in healthy tone and per- 
forming their duties. It is the constant habit 
of breathing plenty of fresh air, waking and 
sleeping, that keeps the blood supplied with the 
oxygen that is vitally essential for both mother 
and fetus, not only in the building of tissues but 
in expelling through the lungs much of the 
waste matter. It is the taking of quantities 
of fluids, water particularly, that dilutes the 
poisons and aids in washing them away through 
the kidneys and skin. 

When poisons do accumulate in the system 
the mother is usually forewarned of their exist- 
ence by certain definite symptoms. These symp- 
toms are: first, the persistent vomiting; second, 
intractable headaches; third, dizzy spells with 
faintness; fourth, swelling of the feet, and the 
swelling of the hands, arms and face which is 
more significant than the swelling of the 
feet and limbs; fifth, blurring of the vision 
and dark spots seeming to float before the eyes; 
sixth, shooting or darting pains in various parts 
of the body with jerking and twitching of the 



NAUSEA AND VOMITING 55 

muscles. Any one of these symptoms alone 
may not mean a serious accumulation of poison, 
but two or three or all of them appearing 
together call for your physician's immediate 
care. Persistent vomiting or the poisons of 
pregnancy may bring on a miscarriage. There- 
fore, early attention to their relief is imperative. 

It is to avert this readily developed condi- 
tion of toxemia or poisoning of the system that 
repeated and careful examinations of the urine 
should be made by your physician throughout 
pregnancy, particularly every two weeks after 
the fourth month. 

Albumin may appear in the urine any time 
during pregnancy. This is a sign that the 
poisons circulating in the. blood have injured and 
impeded the work of the kidneys. Albumin is 
one of the nourishing elements taken up from the 
food by the blood and retained until used where- 
ever it is needed in the structures of the body. 
When the filtering process of the kidneys be- 
comes injured by the poisons, this albumin is 
allowed to drain out into the urine instead of 
being stored in the body for use. While this 
means a loss of nourishment, we are mostly 
concerned with its appearance in the urine as 
a danger signal of accumulated poisons, and 
its prompt heeding by your physician will enable 
him to help avert serious trouble that might 
quickly ensue. 



56 MATERNITY AND CHILD CARE 

A woman may have none of these symptoms 
yet still have albumin in her urine. This is 
only to be discovered by an examination of 
the urine. On the other hand, she may have 
two or more of these symptoms and her urine 
not show albumin. But while the kidneys may 
stand up under the strain of the poisons that 
accumulate in the blood and still take proper 
care of the albumin, they may show another 
sign of accumulated poisons which are respon- 
sible for these symptoms. Let me illustrate: 
In the urine that is excreted daily, there are 
certain proportions of water and a certain part 
of solid matter in solution, or dissolved in the 
water. This solid matter bears a definite rela- 
tion to the weight of the body and to the food 
eaten. A woman weighing one hundred pounds, 
on a certain diet, excretes in her urine daily 
just so much of this solid matter when her 
organs are functioning properly. One weighing 
more and eating more, passes off more solid 
matter. The amount of this solid matter is 
thus an indication of the condition of the kid- 
neys and other organs. When the solid matter 
is below the correct proportion, something is 
wrong — the accumulated poisons are stopping 
the machinery. Examination of the urine to 
determine the amount of solid matter must be 
made in a laboratory. 

Eclampsia. — Now we come to a matter which 



NAUSEA AND VOMITING 57 

I urge you to heed well. If these poisons are 
allowed to accumulate in the pregnant woman's 
system; if she has not heeded the danger signals 
or has not had examinations of her urine and 
pursued the necessary treatment for her case; 
just before confinement or during labor, there 
is apt to develop a serious condition known as 
eclampsia and which is accompanied by con- 
vulsions and loss of consciousness or a state 
of coma oftentimes proving fatal. 

Treatment for the Poisons of Pregnancy. — 
In the preceeding paragraphs we have become 
familiar with the state of the system when 
affected by the poisons or toxemias of preg- 
nancy. A demonstration of the treatment for 
this condition can be made by holding up before 
your eyes a test-tube or little glass vial con- 
taining a substance of the same chemical compo- 
sition as the tissues and blood of your body as 
they exist when in a healthy, normal condition. 
I will pour into this tube, water, representing 
the water you drink. You will see that the 
substance in the tube remains unchanged except 
that a very small amount of the water is ab- 
sorbed. This normal state is called alkaline 
and it is in this condition that the body must 
remain to be healthy. Now I will pour into 
this same tube a little acid. The substance in 
the tube immediately begins to absorb quantities 
of the water and as the water is absorbed, the 



58 MATERNITY AND CHILD CARE 

tissue swells. This is what we call an acid 
state, and results from putting some acid sub- 
stance into the healthy tissue and blood of your 
body. 

What we have just seen taking place in our 
imaginary test tube, is exactly what happens in 
the human body. When poisons accumulate 
they act upon the tissue and blood and other 
body fluids just as the acid poured into the tube 
acted. The tissue begins to swell and absorb 
great quantities of the water you drink and 
retains it preventing it from properly carrying 
off the poisons through the kidneys and skin. 
This is known as a condition of acidity, or an 
acid state of the body and it accounts for the 
swellings of the face and arms and hands. This 
is what takes place in Bright 's disease when the 
whole body begins to swell and take up quanti- 
ties of water, far more than the normal amount 
that should be retained in the tissues. 

The thing to do is now very clear. We must 
introduce more alkalies to help counteract the 
poisons. There are two things to be done. 
First, regulate the diet. Second introduce into 
the system as rapidly as possible the most help- 
ful alkalies. 

The diet is easily regulated. As meat is the 
animal protein that most greatly aggravates 
this condition of acidity, we must promptly 
strike out all meats and meat soups or broths 



NAUSEA AND VOMITING 59 

from the diet. We must confine ourselves ex- 
clusively to milk, especially buttermilk, and 
vegetables and fruits. Because the acid of fruits 
is a different kind of acid from the acid state 
of the system in this condition of poisoning, 
and acts as a neutralize^ we can safely include 
all fruits that the mother is in the habit of 
taking well. She must drink plenty of water, 
three quarts a day is not too much to help 
carry off the poisons and a very free action of 
the bowels must be promptly established, pre- 
ferably by the use of Epsom salts or magnesium 
citrate. This must be repeated in quantities to 
cause two or three watery movements daily. 

There are two ways to introduce alkalies. 
Taking sodium bicarbonate by the mouth is an 
old way, but its drawback is that when con- 
tinued for any length of time it greatly upsets 
the stomach in many women. The best method 
in use today is the one established by the great 
surgeon, Dr. J. B. Murphy, and is called "The 
Murphy Drip." This consists of a simple solu- 
tion of three teaspoonfuls of sodium bi-carbonate 
and one-half teaspoonful of sodium bromide dis- 
solved in a normal salt solution. A normal salt 
solution is made by dissolving three level tea- 
spoonfuls of table salt in one quart of water. 
Put this solution, as hot as it can be well borne, 
into the bowels drop by drop, so that practi- 
cally all of it will be absorbed into the blood 



60 MATERNITY AND CHILD CARE 

and little or none of it run out. This can be 
done by using a fountain syringe and arrang- 
ing the clamp so that the water comes out drop 
by drop. The patient must lie prone on the 
bed and let this treatment take three hours. 
Then rest for three hours, and take the drip 
treatment for a second three hours. If the 
nausea, vomiting and headache have been severe, 
nothing should be given by the mouth for twenty- 
four or forty-eight hours except water. If de- 
sired, a little bi-carbonate of soda can be dis- 
solved in the drinking water. This is some aid 
in increasing the alkalinity of the blood. The 
sodium bromide in the solution not only adds 
alkaline to reduce the acidity but it has a sooth- 
ing effect and helps reduce the nausea. 

The advantage of this treatment is that it 
can be carried out in the home and requires no 
hospital equipment. It is one which every woman 
can take herself and it will rarely fail to give 
prompt relief. This same solution can be intro- 
duced into the system by means of the enema, 
the patient lying down and retaining the fluid as 
long as possible. In this way much is absorbed 
and the enema can be taken twice a day until 
relief is obtained. For an enema use the long 
rectal point of the regular fountain syringe. 
Use sterile vaseline so that it will not irritate 
the rectum. In using the "Murphy Drip/' pro- 
cure from your druggist the No. 18 or 20 male 



NAUSEA AND VOMITING 61 

catheter, which can be passed up into the rectum 
for about eight or ten inches allowing nearly 
all of the fluid to be retained, or, if you cannot 
secure the latter, procure the small size soft- 
rubber rectal tube which can be connected to the 
syringe and also can be passed into the rectum 
as far as the rubber catheter. This treatment 
must be contnued until all symptoms of the 
poisoning have disappeared. 



CHAPTER VI 

SPECIAL CARE OF THE BOWELS, KIDNEYS, 
SKIN AND LUNGS 

All waste matter of the mother and the fetus 
must be gotten rid of through the bowels, kid- 
neys, skin and lungs, and unless these portals 
of exit are kept constantly active, trouble will 
surely result. Too much attention cannot be 
given to every detail which contributes to the 
healthy activity of these four organs if preg- 
nancy and confinement are to be made safe and 
comfortable. 

THE BOWELS 

The bowels carry off tremendous amounts of 
poison. Any failure of their proper activity 
for a single day has a dire influence upon the 
entire system. Headache, lassitude and depres- 
sion which, following even a mild case of con- 
stipation, are only signals that poisons which 
should have been gotten rid of through the 
bowels have piled up in the system. In preg- 
nancy constipation is very common. 

The first and ideal way to correct constipation 
is through the diet. One thorough movement 

62 



SPECIAL CARE OF THE BOWELS 63 

must be had each day and unless this has taken 
place, a soap-suds enema must be used with- 
out fail before retiring because the accumulated 
poisons remaining in the bowel overnight will 
of necessity be absorbed into the general system 
in great amount, and it is this accumulation of 
poisons that threatens the mother's safety. It 
is important that through diet or through the 
means described in the following paragraph, 
the bowels be kept so regulated that an enema 
need seldom be resorted to because its con- 
stant employment is a habit as much to be 
avoided as the repeated use of cathartics. 
Furthermore, the enema moves only the mass 
in the lower bowel and does not wash away 
the poisons from the upper bowel. 

Coincident with attention to the diet, the 
mother should make every effort to establish 
a regular time each day for the evacuation of 
the bowels. One of the aids in this matter is 
the drinking of one or two glasses of water 
regularly upon rising in the morning, providing 
it does not increase the nausea that is found 
occurring during the first three months of 
pregnancy. 

Graham bread, whole wheat bread, bran bread, 
or bran cooked with cereal, all kinds of fruits 
and vegetables except white navy beans, and 
especially the fresh fruits and vegetables, are of 
inestimable value. I have found with manv 



64 MATERNITY AND CHILD CARE 

patients that a light fruit meal at bedtime is 
very helpful. This consists of dates, figs, apri- 
cots, prunes, pears or peaches, a little apple 
sauce or baked apple taken with a glass of 
warm milk, or if milk is not well taken this 
light fruit meal can be eaten to equal advantage 
with a glass of water. 

In spite of attention to diet, constipation may 
sometimes persist and then the safest and 
simplest remedy is one of the mineral oils, such 
as liquid albolene, Nu-jol or Interol, two or 
three tablespoonfuls at bedtime. Olive oil can 
be used successfully although much of the olive 
oil is absorbed in the intestine and its steady 
use is fattening. However, the poorly nourished 
mother suffering from constipation finds it a 
most desirable measure. 

The most effective and agreeable remedy for 
constipation at any time for adults and chil- 
dren, I call the "Most Pleasant Formula." It 
consists of one pound each of dates, figs and 
raisins with one-half ounce of senna leaves, 
run through a meat grinder three or four times 
and kept in a covered glass jar. Take one or 
two teaspoonfuls at bedtime. This is effective, 
good to take, and a harmless laxative food. 
When traveling, or in some way prevented from 
employing the best and safest measures to offset 
constipation, a three or five-grain cascara pill 
can be taken at bedtime. 



SPECIAL CARE OF THE BOWELS 65 

THE KIDNEYS 

The proper functioning of the kidneys through- 
out pregnancy is of the utmost importance. One 
of the first duties of your physician is the mak- 
ing of regular and systematic examination of the 
urine during the whole term of gestation. 

During the first weeks of development the 
extra work put upon the kidneys is little and 
the urine need be examined only every three 
weeks. But from the beginning of the fourth 
month until confinement, the examination of 
the urine should be thorough every two weeks 
and should complications develop, specimens 
should be collected and sent to a laboratory for 
complete examination. When the kidneys show 
signs of failing to do their proper work, your 
physician should make more frequent examina- 
tions than every two weeks. Urine for examina- 
tion should be collected for a period of twenty- 
four hours. Specimens of single excretions are 
not of value in making tests. Scald a glass 
covered jar in boiling water. Throw away the 
first urine passed in the morning begin collect- 
ing the rest of the urine passed during the day 
and night, also the first urine passed the follow- 
ing morning. Keep it well covered. This gives 
a full twenty-four-hour excretion of the kidneys. 
Have a bottle of chloroform ready and put one 
teaspoonful into the urine at any time while 



66 MATERNITY AND CHILD CARE 

you are collecting it. This prevents decomposi- 
tion. The amount for the twenty-four hours 
should be carefully measured and well shaken 
together. From this entire amount, four to 
six ounces should be poured into a perfectly 
clean bottle, tightly corked or sealed promptly, 
and labeled with the exact amount passed during 
the twenty-four hours and from which the small 
specimen is taken. 

The reasons for collecting a twenty-four-hour 
specimen of urine for examination are: first, 
the entire amount shows whether you are pass- 
ing a sufficient amount of urine. If the amount 
is less than one quart it shows that you should 
be drinking more water. Second; there might 
be trouble indicated in a twenty-four-hour excre- 
tion of the kidneys that would not show in a 
single specimen. Third; it is not albumin alone 
that the urine is examined for but to ascertain 
the amount of solid matter in solution in the 
urine that is passed in the twenty-four hours, 
as in the event that there are symptoms of 
poisoning and a laboratory test is to be made 
instead of the usual physician's examination, 
this definitely shows whether or not the kidneys 
and other organs are being blocked in their 
duties by poisons accumulating in the system. 
Fourth; the twenty-four-hour specimen is needed 
because at times the mother may have painful 
and frequent urination accompanied by fever 



SPECIAL CARE OF THE BOWELS 67 

and oftentimes a chilly sensation for which the 
physician is sometimes at a loss to account. A 
complete specimen of the urine may disclose 
the presence of pus, indicating an infection of 
the bladder known as cystitis; or else an infec- 
tion of the kidneys even higher up, in the pelvis. 
Do not become alarmed at sediment in the 
bottom of the jar of collected urine, thinking 
this an indication of trouble with the kidneys. 
Sediment appears in perfectly normal urine 
when it cools or has stood long enough to de- 
compose. Remember also, that pain in the back 
is not as commonly supposed, a sign of trouble 
with the kidneys, but in pregnant women is not 
infrequently due to a strain placed upon the 
muscles of the back by the tipping forward of 
the enlarging uterus. 

SKIN AND BATHING 

Careful care of the skin by proper bathing 
and the wearing of sufficiently warm clothing 
is needful. In pregnancy extra poisons are 
thrown off through the pores of the skin and 
if these pores are not kept free by the daily 
sponge or tub bath they become clogged and 
the poisons are kept in the system. Never take 
very hot baths or hot steam baths except on 
your physician's advice. The cold sponge or 
tub bath should not be taken unless your system 
is well accustomed to it and thou only in the 



68 MATERNITY AND CHILD CARE 

first three months of pregnancy. The warm 
bath at bedtime often greatly facilitates sleep. 

Skin Changes. — As pregnancy progresses the 
area around the nipples becomes very much 
darker and a dark band of skin runs perpen- 
dicularly down the center of the abdomen. Such 
dark areas may appear elsewhere beneath the 
skin. As the uterus enlarges the skin is greatly 
stretched over the lower part of the abdomen 
and the under layers break in places, producing 
red streaks which extend upward laterally, not 
uncommonly appearing over the forward part 
of the thighs. Later these red streaks become 
white. Massaging with olive oil, vaseline or 
cold cream, while not preventing the streaks 
from forming, may relieve the sensation of 
stretching of the skin. 

Clothing. — The clothing must be sufficiently 
warm so that the skin is kept from chilling and 
so that the sweat glands may remain active in 
their process of excretion. The clothing next 
the skin, except in warm weather, should be of 
light wool for wool takes up the perspiration as 
cotton does not, and keeps a warm and dry layer 
next to the skin. There are excellent combina- 
tions of cotton-and-wool and silk-and-wool which 
are non-irritating for those who cannot bear all- 
wool next the flesh. If possible all of the gar- 
ments should be suspended from the shoulders 
to avoid the strain of bands about the waist. 



SPECIAL CARE OF THE BOWELS 69 

Tight clothing should not be worn about the 
chest as this prevents deep breathing. 

Skirt bands should never be so tight as to 
constrict the abdomen. Wear common sense 
shoes with broad low heels which bring the 
weight directly over the arch. High heels tip 
the pelvis forward, putting an unnecessary strain 
on the muscles of the abdomen and resulting 
in severe backache. 

Up to the third month the regular corset may 
be worn if not laced tightly. After that time 
wear a correctly fitted maternity corset, one that 
gives the muscles of the abdomen proper sup- 
port. After the third month, as the uterus en- 
larges, it tends to fall forward and if unsup- 
ported puts too great a stretch or strain upon 
the muscles. If the scientifically designed ma- 
ternity corset is worn, these muscles keep their 
tone and this retained tone is of great assistance 
in supporting the uterus at the time of labor. 

The properly fitting maternity corset should 
come well down around the hips and lace below 
the abdomen so that the uterus receives support 
from below. From there the corset should arch 
forward, allowing room for the expansion of the 
uterus. It should come high enough to support 
the breasts, but should never be laced tightly 
against them to compress either the breasts or 
the lower part of the chest. Lace the corset from 
below upward. It should be unlaced every day 



70 MATERNITY AND CHILD CARE 

and put on in the morning when the mother rises 
from her bed and before getting on her feet. 
She should lace the corset snugly just below the 
abdomen in order to give all the organs support 
from below, and draw the laces loosely over the 
abdomen and chest. 

Care should be taken never to lace the corset 
tightly directly over the abdomen as harm can 
be done to both mother and child by this pres- 
sure. The skirt band can be supported from the 
corset and this also prevents a constriction of 
the uterus. 

The Night Belt. — A belt such as the Storm belt, 
which can be purchased in the shops should be 
worn at night to give support to the heavy and 
enlarged uterus. This can readily be made at home 
of some good, strong washable material. The belt 
comes well below the abdomen to give it support 
and should be made to lace at the back or sides to 
be readily adjusted for comfort. The night belt 
can be worn on hot days when the corset becomes 
irksome and will give fairly good support when 
active exercise is not being taken. 



CHAPTER VII 
THE CARE OF THE BODY 

The first question the prospective mother asks 
when her pregnancy has been determined, is: 
"What must I do, and what must I not do, to 
give my baby the best possible start in life?" 

My first warning concerns the advice that will 
be offered from all sides. Many fads and hob- 
bies have been developed and their followers will 
urge you to adopt them. You may have to listen 
quietly to a great deal of advice from kindly 
intentioned people, but you need not take it all 
to heart or try to follow it. 

Pregnancy is a natural, normal condition and 
its only requirement is that you live a natural, 
simple life, doing all things with moderation. 
Exercise regularly each day in the fresh air and 
sunshine. Through the fresh air that you breath 
your baby gets oxygen. By deep breathing and 
a constant supply of fresh air your body and 
your baby's are provided with oxygen which is 
absolutely essential to convert your food into 
energy for yourself and the child. 

Be outdoors two hours each day. Open your 
windows at the top and bottom to provide cir- 

71 



72 MATERNITY AND CHILD CARE 

dilation in your living and sleeping rooms. Even 
in winter the room where you work and sleep 
must receive a constant supply of pure fresh 
air if you are to be well. With a little attention, 
your windows can be arranged with a board or 
glass slanting up from the sill at the bottom so 
that this can be accomplished without draughts. 
Cover yourself warmly enough at night, put on 
a sleeping cap, but keep your window open wide 
enough to flood the room with fresh air all night. 

Whether you work or walk for 'exercise, stop 
before you are fatigued. Sit down or lie down 
and rest about a half hour before you feel tired. 
Your outdoor walk should be only long enough 
to make you feel refreshed. Increase it a little 
each day until you can walk for an hour twice a 
day and not feel tired, but benefited in every way. 
Carry your chest up as you breathe, and by hold- 
ing it high, your shoulders will fall into correct 
position and your abdomen will be held in. Con- 
tinue these daily walks in the open air up to the 
very time of your confinement. 

Avoid constantly sitting, with no exercise. This 
is as disastrous as too violent exercise, such as 
tennis or golf or fatiguing work in laundry or 
kitchen. These are liable to bring on miscar- 
riage in the early months and should never be 
tolerated in the later months. Avoid long rides 
over rough roads. 

If confined to the bed because of illness, 



THE CARE OF THE BODY 73 

swollen limbs or varicose veins, the body should 
be exercised by a gentle massage each day, with 
gentle rubbing over the abdomen and a more 
vigorous manipulation of the muscles of the rest 
of the body to keep up their tone and to stimu- 
late circulation, 

If confined to the house, take deep breathing 
exercises morning and night before an open win- 
dow, but never attempt any form of physical 
culture or calisthenics without your physician's 
advice. 

Hard work during the later months tells upon 
the baby; and it will not be so vigorous, robust 
or well nourished. Guard against exhaustion 
during the later months. You tire more easily 
and should rest more often. Most civilized na- 
tions have a law forbidding the employment in 
shops or factories of a pregnant woman one 
month before and four to six weeks after con- 
finement. This should apply with equal force to 
exhausting work at home. Turkey, Eussia, Italy 
and the United States have no such law. 

The ordinary light housework is an ideal form 
of indoor exercise. It exercises the muscles and 
diverts the mind into many pleasant channels. 
But all hard work, such as family washings, 
scrubbing floors, sweeping, lifting or moving 
heavy objects, or standing long hours on the foot, 
must be condemned. Observe the women who do 
this over-hard work through several pregnancies. 



74 MATERNITY AND CHILD CARE 

There is but one result, broken health and 
thousands upon thousands of cases of chronic 
invalidism. 

The prospective mother should lie down and 
relax completely for one or two hours in the 
middle of the day if she wishes to maintain her 
health during and after pregnancy. She should 
have eight or nine hours of unbroken sleep at 
night. Early in pregnancy learn to sleep on the 
side, which in the later months will insure better 
rest and relief from pressure. A hot water 
bottle at the feet, a warm bath at bedtime, with 
a glass of warm milk or a bowl of gruel, greatly 
reduces sleeplessness. Sleep on a firm smooth 
mattress, and preferably alone, because turning 
or restlessness in the night greatly increases 
your discomfort. Eat your hearty meal at mid- 
day and then a light supper. Do not take drugs 
to produce sleep unless they are taken according 
to your physician's advice. 

Remove all worry and apprehension from your 
mind by placing yourself in your physician's 
care. Do not shun acquaintances; mental diver- 
sion is necessary. Good music, the theatre, con- 
certs, and the daily reading of helpful books are 
all aids. 

Long hard trips by train or auto should be 
avoided during the early weeks because the ovum 
is insecurely attached and exhaustion can easily 
bring on miscarriage; and during the last two 



THE CARE OF THE BODY 75 

or three months because the uterus is irritable 
and contractions can easily occur. 

INDIGESTION 

Heartburn and flatulence cause considerable 
distress at this time. Usually occurring in the 
early months, they may persist throughout the 
entire period. A burning sensation in the stom- 
ach, usually an hour or two after eating, is due 
to an over-secretion of hydrochloric acid. This 
acid is secreted in the stomach to aid digestion 
and during pregnancy there is sometimes an 
over-supply. Fat such as butter, cream or olive 
oil taken thirty or forty minutes before eating 
will greatly lessen this secretion. Take two or 
three tablespoonfuls of olive oil or a half glass 
of rich cream. This will oftentimes relieve the 
heartburn entirely. Do not take these extra fats 
with the meal as this only lengthens the time of 
digestion and allows more acid to be secreted. 
Take them thirty or forty minutes before eating. 
If heartburn persists an hour or hour and a half 
after meals, when the discomfort is severe take 
Husband's magnesia or milk of magnesia, or you 
can obtain from your druggist little squares of 
magnesia which can be chewed. Bicarbonate of 
soda which is sometimes used, is disturbing to 
the stomach and causes indigestion in many. 

The first thing to do when you are troubled 
with flatulence or gas is to correct the consti- 



76 MATERNITY AND CHILD CARE 

pation, which is usually the cause, by the meth- 
ods already given. A great deal of fermentation 
goes on in the stomach and bowels. By following 
the diet suggestions laid down you can be re- 
lieved of much of the discomfort from fermen- 
tation. If it is severe, eat lightly of all starchy 
foods such as beans, potatoes or corn, all fried 
foods, and sweets. When gas distention starts, 
drink buttermilk, preferably that made by your- 
self from the Bulgarian tablets which you obtain 
from your druggist. You can eat the undis- 
solved tablets also and will get a great deal of 
relief. 

CARE OF THE TEETH 

One of the first things the pregnant woman 
should do is to have all cavities of her teeth 
filled. Have X-ray photographs of all your teeth 
if you live where this can be done. If not, it 
will pay to make a trip to a nearby city where 
there is an X-ray laboratory. Abscesses at the 
roots of your teeth cannot be detected otherwise 
and these can do an unlimited amount of harm 
by draining poisons into your system. These are 
especially dangerous during pregnancy as they 
throw extra work on the kidneys which are al- 
ready burdened with the additional duty of 
throwing off the poisons from the child's waste 
as well as from your own. The acid which is 
belched up in the mouth from an over-acid stom- 



THE CARE OF THE BODY 77 

ach corrodes the teeth and decays them, many 
mothers finding this decay rapid during preg- 
nancy. The teeth should be brushed and cleaned 
with dental floss with unusual care at this time, 
allowing no particles of food to collect between 
them. If you will use milk of magnesia or lime 
water to rinse your mouth, also using it on the 
tooth-brush to scrub around the gums, you will 
do much to preserve your teeth during preg- 
nancy. This alkali keeps the acid neutralized. 
Take a mouthful of milk of magnesia and rinse 
your mouth thoroughly with it several times dur- 
ing the day. If cavities occur during the first 
three months they can be filled permanently, but 
later should have temporary fillings. Teeth 
should not be pulled after the third month unless 
in an emergency. 

PBESSURE 

Pressure of the enlarged uterus on the other 
organs causes a great deal of discomfort, often- 
times producing shortness of breath, which is 
usually worse at night when lying down. Lying 
on the side or being slightly propped up by pil- 
lows or by the use of a back-rest in the bed may 
give relief. The kidneys must be carefully 
watched and the urine examined frequently when 
this shortness of breath is present. 

As the uterus enlarges, it presses against the 
veins which run upward from the lower limbs 



78 MATERNITY AND CHILD CARE 

and causes swelling of the feet and legs. This 
swelling of the feet is also a symptom of failure 
of the kidneys and always calls for examination 
of the urine. The swelling is sometimes so se- 
vere that the mother must remain off her feet 
most of the time, keeping off them almost en- 
tirely during the last two months. The best 
relief is obtained by lying down with the limbs 
slightly elevated. As soon as the uterus is 
emptied, the pressure is taken away and the 
swelling disappears. 

As a result of this pressure on the veins, not 
so much during the first pregnancy but very 
often in subsequent ones, the walls of the veins 
of the lower extremities stretch and produce 
varicose veins, so distended and painful at times 
as to cause fear of their bursting. This acci- 
dent is very rare, however. The best relief is 
the silk elastic stocking which can be purchased 
through your druggist. If you cannot obtain 
these take flannel strips about three inches wide 
cut on the bias and sew end to end. These make 
splendid bandages. Wind them on snugly, be- 
ginning at the toes, omitting the heel, passing 
up the leg and even over the thigh if necessary. 
They can be kept clean by washing. Put them 
on in the morning before rising as the veins are 
less swollen after a night's rest. 

The enlarging uterus also presses upon the 
veins which pass upward from the rectum and 



THE CARE OF THE BODY 79 

hemorrhoids are a very common and annoying- 
trouble during pregnancy. Many things can be 
done to relieve painful hemorrhoids. After a 
movement of the bowels, apply very cold or even 
ice water with a soft cloth. Use a glassful con- 
taining one or two teaspoonfuls of witch hazel 
and apply to the affected parts for fifteen or 
twenty minutes. A sitz bath of cold water con- 
taining two or three tablespoonfuls of witch hazel 
gives relief. Sit in this twenty or thirty minutes. 
Adrenalin ointment applied after this cold appli- 
cation, or the use of Adrenalin suppositories, 
gives great relief. No attempt should ever be 
made to operate upon hemorrhoids during preg- 
nancy. 

CARE OF THE BREASTS 

The breasts need not be given any special at- 
tention in the early months of pregnancy. But 
beginning with the sixth month the nipples should 
be washed each day with soap and water, using 
a soft cotton or gauze wash-cloth. By the sev- 
enth month, each day after bathing the breasts, 
apply on a piece of sterile cotton or gauze a 
solution made up of one teaspoonful of boric 
acid crystals dissolved in three ounces of alcohol. 
This hardens the nipples and prevents the de- 
velopment of cracks and fissures during nursing. 
It is through sore nipples that infections gain 
entrance to the breast, resulting in abscess and 



80 MATERNITY AND CHILD CARE 

entrance to the breast, and it is these infections 
that result in abscess and defeat attempts at 
nursing. 

Flat and retracted nipples should be gently 
massaged and very gently pulled out with the 
thumb and fore-finger in order to elongate them 
so the baby will be able to nurse. 

THE DOUCHE 

Mothers often ask if the use of the douche 
during pregnancy is harmful. At this time there 
is commonly more or less discharge from the 
vagina. The glands at the mouth of the womb, 
because of the great increase in the blood sup- 
ply of the uterus, become more active and throw 
off an increased amount of secretion. As long 
as this discharge is not troublesome or irritating 
to the skin around the vagina, the use of the 
douche is unnecessary and not advisable. 

Some mothers insist upon the use of the douche 
believing it necessary for cleanliness, but it 
should never be used in the last three months 
of pregnancy. In using the douche for cleanli- 
ness, the water should be boiled but never used 
hot. The douche point, which should preferably 
be of glass, should be boiled so that it is per- 
fectly sterile. In each quart of warm water the 
use of one level teaspoonful of aluminum acetate 
or two level teaspoonfuls of table salt is cleans- 
ing and mildly astringent, especially the alum. 



THE CARE OF THE BODY 81 

A very good external substitute for the douche 
is the sitz bath, especially where the discharge 
from the vagina is irritating. This can be taken 
in a small tub or wash bowl placed on a low 
stool. The water should be about the body tem- 
perature and you should sit in it for twenty or 
thirty minutes, letting it well cover the affected 
parts. After this bath you can dust the irritated 
skin with powdered zinc oxide or apply zinc 
oxide ointment containing ten per cent of white 
wax. If hemorrhoids are also troublesome the 
sitz bath can be taken in considerably cooler 
water as cold water relieves the hemorrhoids. 



CHAPTER VIII 

THE INTERRUPTIONS OF PREGNANCY— MIS- 
CARRIAGE AND PREMATURE BIRTHS 

By interruption of pregnancy, I mean the ex- 
pulsion of the fetus from the womb for any 
cause before it has reached full development. 
One of the first causes is inflammation of the 
lining of the womb, called endometritis. Any 
chronic inflammation of the womb can terminate 
pregnancy at any time. If a mother has suf- 
fered an interruption of pregnancy she should 
consult her physician to determine whether or 
not in his opinion she has symptoms of chronic 
inflammation and receive the treatment to cor- 
rect it. 

Another common cause of miscarriage is dis- 
placement, the womb being out of its normal 
position. This only serves to emphasize how 
important it is before the physician discharges 
his patient after labor to determine by local 
examination that the womb is in correct position. 
Appropriate treatment applied at this time will 
often permanently correct a misplacement. 

Accumulation of poisons in the system during 
pregnancy, allowing a condition of toxemia to 

82 



INTERRUPTIONS OF PREGNANCY 83 

exist, and an impoverished condition of the blood, 
known as anaemia, are causes of miscarriage. 

A very prevalent cause of miscarriage is either 
inherited or acquired chronic blood disease 
known as syphilis. This disease may exist in 
the blood unknown to the mother. A mother 
who has been the victim of repeated miscarriages, 
where no other cause is plausible, should not 
fail to have the proper blood test, known as the 
Wasserman. 

There is another condition not commonly un- 
derstood, which is referred to as habitual mis- 
carriage, in which the muscles of the uterus seem 
to be in an irritable state. In this condition some 
slight cause such as running a sewing machine, 
over-reaching, running rapidly up and down 
stairs, or any violent exercise, may bring on mis- 
carriage. Where this tendency exists the mother 
must pay the strictest attention to all the rules 
of hygiene laid down in the chapter entitled. 
The Care of the Body. Experience shows that 
in this class of women miscarriage is more apt 
to occur at the usual menstrual time, and by 
remaining in bed through what would be the reg- 
ular menstrual periods each month, many women 
can often go successfully through the term of 
pregnancy. Women prone to miscarry should 
keep quiet at all times and avoid all physical 
strain. 

For reasons not clearly understood miscar- 



84 MATERNITY AND CHILD CARE 

riage is liable to occur in women who become 
very fleshy. High altitudes and change to hot 
climates in those not accustomed to them, may 
be causes of miscarriage. Tuberculosis in the 
mother, or any of the acute infectious diseases, 
accompanied by a high fever, are very likely to 
result in miscarriage. The condition of the 
nervous system is also of prime importance. It 
is undoubtedly true that severe nervous or 
mental shocks are capable of interrupting preg- 
nancy at any time during its course. 

Miscarriage occurs most frequently between 
the second and third month. After the fourth 
month it is uncommon. Interruptions of preg- 
nancy are more frequent after the first birth and 
are more liable to occur with each successive 
pregnancy. The woman who is pregnant repeat- 
edly with short intervening periods is subject to 
frequent miscarriages. 

The following symptoms of miscarriage and 
the knowledge of what to do should it occur are 
of importance. During the early weeks termi- 
nation of pregnancy may occur with very little 
pain, but in almost all instances there is severe 
hemorrhage. Should the miscarriage happen 
during the second, third or fourth month, the 
pain and especially the hemorrhage are decid- 
edly more severe, the hemorrhage often being 
so great as to endanger life. 

Perhaps the symptoms that will first attract 



INTERRUPTIONS OF PREGNANCY 85 

the attention will be a slight chilly sensation and 
pain in the back. The backache may be slight 
or severe accompanied by a marked bearing- 
down sensation and a feeling of heaviness in the 
lower part of the abdomen. A feeling of faint- 
ness and exhaustion is present, especially if there 
is any considerable loss of blood. After the fifth 
month an interruption of pregnancy is attended 
with great danger. At times an operation be- 
comes necessary. The loss of blood and the 
accompanying pains are similar to those which 
accompany a normal delivery. 

Whenever you have a slight bloody discharge 
immediately go to bed in a darkened room where 
you can have rest and quiet. The position should 
be on the back, with as little change as possible. 
If the bleeding is only slight and ceases promptly 
with this treatment you may be out of bed in 
about three days. Many times after such symp- 
toms have appeared and a rest in bed for several 
days has been taken, pregnancy has gone on to 
its full term without further interruption. If 
there is any return of the hemorrhage following 
the period of rest go back to bed and remain 
there for at least two weeks. 

The most important thing is to immediately 
call a physician as soon as any of these symp- 
toms appear. If it is not possible to get medical 
advice at once, this outline of the important 
points of the treatment will instruct you as to 



86 MATERNITY AND CHILD CARE 

what to do for yourself. Should the bleeding 
become profuse, have someone elevate the foot 
of the bed two feet. "When the hemorrhage has 
stopped the bed may be gradually lowered. Re- 
member that rest in bed for at least two weeks 
is important. 

When miscarriage actually occurs it is of the 
utmost importance for your future health that 
your after treatment be exactly the same as 
though you had been delivered at the full term. 
The details of this treatment after delivery are 
taken up in a later chapter. When the mother 
gets on her feet too soon, severe displacements 
and chronic invalidism are almost sure to result. 
After miscarriage the uterus is in an irritable 
condition and demands prolonged and complete 
rest. If another pregnancy occurs within a 
year's time after a miscarriage, there is grave 
danger of the same result. 

THE PREMATURE BABY 

The nearer a baby approaches his full term 
at birth the greater is his chance for survival. 
Weight alone is not a guide as length is most 
important. It has been found that when the 
length is 17 to 18% inches the chances of living 
are fifty to ninety-six per cent. From 17 inches 
to 16 inches the chances are fifty per cent down 
to 20 per cent. (See page 27.) 



INTERRUPTIONS OP PREGNANCY 87 

Babies weighing less than four pounds rarely 
live. 

The premature baby will lie in a quiet apathetic 
state, moving its arms and legs very little if at 
all. The cry is a feeble wail in sharp contrast 
to the lusty cry of the full-term baby. The 
muscles are weak and flabby, the breathing irreg- 
ular and shallow and the proper amount of air 
is obtained with great difficulty. This accounts 
for the bluish tinge of the skin so commonly ob- 
served in premature babies. Another peculiar- 
ity of the skin is a yellow or jaundiced look 
which is very slow in disappearing. 

The temperature is below normal and must be 
taken by the rectum. Every effort must be put 
forth to keep the body temperature as near nor- 
mal as possible; life depends upon this. A spe- 
cial small basket that can be kept warm with 
hot water bottles and packed with cotton in 
which the baby can lie with little handling, warm 
and out of any draught, is fully described with 
the proper care for the premature baby in the 
volume, The Proper Feeding of Infants. 

The muscles of the mouth are often too feeble 
to permit nursing and these premature babies 
must be fed the mother's milk from a medicine 
dropper. The organs of digestion lack full de- 
velopment so that the premature baby deprived 
of breast-milk has a greatly lessened chance of 
survival. 



88 MATERNITY AND CHILD CARE 

Causes of Prematurity. — The physical condi- 
tion of the mother is the most important of the 
many causes of prematurity. Heading the list 
are tuberculosis, alcoholism, and inherited 
chronic blood diseases. The diseases in mothers 
which are most often the cause of prematurity 
are the ones which in my opinion should be con- 
sidered sufficient reason for a woman's not at- 
tempting pregnancy. 

Women suffering from chronic inherited blood 
disease, tuberculosis, Bright 's disease, heart dis- 
ease, severe anaemia, exothalmic goitre, (this is 
the pernicious type of goitre, accompanied by 
bulging of the eyeballs and rapid pulse, and does 
not refer to the ordinary simple goitre) will, if 
they become pregnant, aggravate their own con- 
dition and endanger their lives during pregnancy 
and confinement. In the vast majority of cases 
they will bring into the world children who have 
far less than an even chance to survive even 
when surrounded by the most favorable of cir- 
cumstances. If these babies are carried to full 
term, they will usually be congenitally weak with 
many of the characteristics of premature infants 
and with all the attendant difficulties to overcome 
in the effort to save their lives. 

Accidents occurring in the latter months of 
pregnancy, especially if associated with physical 
injury or nervous shock, are extremely liable to 
precipitate labor. 



CHAPTER IX 

MATERNAL IMPRESSIONS AND REAL 
PRE-NATAL INFLUENCES 

Long before most women know that they are 
pregnant the infinitely tiny cells of the impreg- 
nated ovum have arranged themselves in the 
various groups that evolve into the organs of 
the child. Only occasionally do the cells fail to 
assume the normal order, a few from one group 
becoming by some mistake of nature attached 
to another group. This results in deformities 
and markings. This accidental misarrangement 
of the cells of the embryo takes place entirely 
independent of any influence of the mother, often- 
times before she is even aware of its existence. 

In the early weeks of pregnancy the growing- 
embryo has assumed complete shape and the 
forming or any possible deforming in the group- 
ing of the cells has been brought about. Such 
events as unpleasant sights or tales or news, 
which mothers sometimes ascribe as the cause 
of marking their babies, take place invariably 
after this early arrangement and adjustment of 
cells in the embryo. Therefore, their connection 

89 



90 MATERNITY AND CHILD CARE 

with any marks found on the child at birth is 
illogical when we know that by the end of the 
eighth week the form of the fetus is definite and 
is not subsequently altered. 

We know that some children have been made 
defective because the mother has been allowed 
to go through long, protracted and difficult labor 
and the baby has been injured during birth. But 
our modern skill in confinement has done away 
with these mishaps which occurred to our moth- 
ers and grandmothers. 

We do know definitely and positively that vice 
and alcoholism are the two greatest influences in 
the production of both physical and mental mal- 
development in our children. It is a well-estab- 
lished fact that alcoholism of one or both parents 
greatly increases the number of premature and 
still-births and the number of defective children. 

One interesting fact is that in alcoholic fam- 
ilies, the mortality is least among the first-born 
and increases steadily in the later children. One 
well-known physician reports a case of a normal 
woman married to a sober man who had three 
normal, sound children. After his death she 
married a habitual drinker and gave birth to 
three defective children, one an epileptic and 
two who died of tuberculosis. Alcoholism as a 
prenatal influence in the production of epilepsy 
in the children has been an appalling fact in my 
experience. Among eighty-three epileptic girls 



MATERNAL IMPRESSIONS 91 

in one institution I found sixty born of alcoholic 
parents. 

The subject of consanguinity or blood relation- 
ship has perhaps been more thoroughly investi- 
gated by Alfred H. Huth than by any other 
writer and to him we are indebted for the fol- 
lowing information: " There is an entire lack 
of evidence that consanguinity is in any way a 
factor in causing mal-development excepting as 
it perpetuates and emphasizes any defects or 
weaknesses in the families in which this inbreed- 
ing occurs/ ' 

Tubercular children born of one or two tuber- 
cular parents are not tubercular at birth but are 
infected after birth through the mother's breast- 
milk and through contact in the home life with 
the parents. Our greatest authorities on tuber- 
culosis declare that if the child born of tuber- 
cular parents is not allowed to come in direct 
contact with them for the first five years of its 
life, the chances of immunity are equal. 

Nature has also fortunately made provision 
in the case of the mother suffering from an in- 
herited or acquired blood disease, in that she 
is many times sterile and if pregnancy takes 
place it does not often carry the child to the 
full term. I say fortunately, for in cases of 
syphilis the results are much the same as those 
following alcoholism. 

I want to emphasize the proper care of the 



92 MATERNITY AND CHILD CARE 

nervous system in its relation to successful moth- 
erhood. I want to address not only the pros- 
pective mother, but the father as well, and all 
those whose privilege it is to companion the 
woman whose body is the mysterious portal of 
a new life. 

A noted American surgeon a few years ago 
startled the medical world by the publication 
of his exhaustive experiments and studies in the 
relationship of health and nerve exhaustion. He 
proved clearly and beyond a question of a doubt 
how our nerve energy, which might be compared 
to electrical force, is generated and stored in our 
body tissues as we sleep and rest. He showed 
how mental energy used up the store of this 
nerve reserve power more rapidly than physical 
work. He demonstrated how fear, worry and 
pain depleted the reserve and even exhausted it, 
emptying the storehouses completely in a few 
moments at times of great stress. Of the many 
facts brought to light by these studies perhaps 
the most interesting was the location in the body 
of these reserve stores of nervous energy. The 
brain quite naturally was the seat of one of the 
storehouses, but the finding of the other two 
reservoirs in the liver and the super-renal glands 
located above the kidneys was a surprise. 

When the supply of potential energy stored 
up in these three places is totally exhausted, 
complete collapse of our physical forces is the 



MATERNAL IMPRESSIONS 93 

result. Fainting is an illustration of this con- 
dition and shock following a surgical operation 
is another example. Even when the conscious 
mind has been put to sleep by the use of an 
anaesthetic, the nerves are carrying messages of 
pain from the seat of the operation to the foun- 
tain heads of stored-up nervous energy, and as 
a consequence this energy is rapidly depleted. 

Not a single function of the body will operate 
normally if you allow anything to deplete your 
controlling and sustaining nervous force. 

"Worry, fear, anxiety, lack of physical and of 
mental rest will prevent you from laying in this 
needed store of nerve energy. And if you ap- 
proach the period of confinement nervously worn 
out and exhausted with the care of the house- 
hold, full of fear and apprehension, you can 
readily see how quickly your small reserve will 
be exhausted. 

If, on the other hand, husband, relatives and 
friends co-operate with the prospective mother 
during the latter months of pregnancy, and free 
her from worry, petty annoyances and anxiety 
which increase the nervous strain of her normal 
life, it will do more than all other measures to 
insure a successful confinement. 

It is thus easy to understand why women who 
are able to avail themselves of the advantages of 
a hospital for their confinement, pass through 
this and the convalescent period so successfully. 



94 MATERNITY AND CHILD CARE 

They are entirely separated from the cares and 
worries of the household. They enter the hos- 
pital sustained with the confidence that every- 
thing is at hand to render them the best service 
possible and to reduce to a minimum the anxie- 
ties associated with the care of the new baby. 

While the energy storehouses are being refilled 
after confinement, the mother must continue her 
rest at all expense. The one who struggles 
out of bed in a week or ten days to assume 
charge of her home and new baby, keeps her 
nervous and physical system exhausted, and is 
the one who nearly always fails to successfully 
nurse her child. The mother who follows the 
common practice of getting back to her old rou- 
tine of duties two weeks after her baby is born, 
after two or three pregnancies is the one who 
begins to show signs of breaking, 



CHAPTER X 
PREPARING FOR CONFINEMENT 

The greatest danger to the mother at the time 
of confinement is infection. Infection may not 
only endanger her life but be responsible for 
years of chronic invalidism. Practically the 
whole secret of successful confinement is found in 
the word asepsis. The thorough sterilization of 
everything that comes in contact with the mother 
during labor cannot receive too strict attention. 

The dangerous infection that results from the 
failure to sterilize everything used about the 
mother during labor, and one often carried into 
the vagina by examinations at this time, is that 
resulting in child-bed fever, medically termed 
puerperal sepsis. 

This infection not only endangers the mother's 
life but it is contagious and can be carried from 
mother to mother on instruments, on clothing 
and by the nurse or physician. This fact was 
given to the medical world by the famous Dr. 
Oliver Wendell Holmes as long ago as 1843. 

It is a strange fact that everyone realizes how 
important it is to observe strict cleanliness and 
asepsis, whenever a surgical operation is per- 

95 



96 MATERNITY AND CHILD CARE 

formed, yet when a mother is delivered of a 
child, in which there is almost equal chance of 
infection, there is such carelessness and neglect 
of the details of asepsis. 

If the following simple but essential precau- 
tions of a character that can be readily carried 
out in every home are taken, an infection will 
rarely occur, and if an occasional case should 
follow, despite all possible safeguards, it will be 
mild and easily controlled. 

A Word About Sterilization. — All harmful 
bacteria can be killed in one half hour by steam, 
or in a hot oven at baking temperature, or by 
boiling, so that complete sterilization can readily 
be accomplished at home. Those who live in or 
near cities can obtain at a nominal cost from 
most hospitals a complete carefully sterilized 
outfit to be used at the time of labor. 

It would be a good investment for the pros- 
pective mother to purchase and have ready for 
use two pairs of surgeon's rubber gloves. No 
matter how thoroughly the hands are scrubbed 
they cannot be completely sterilized, yet a pair 
of surgeon's gloves can be quickly and com- 
pletely sterilized in boiling water, and if there 
is any suspicion that they may have become 
soiled they can be instantly rendered safe again 
by plunging into boiling water. During the proc- 
ess of delivery they can be repeatedly washed in 
a strong antiseptic solution while still on the 



PREPARING FOR CONFINEMENT 97 

hands, and then rinsed in plain sterile water. 
With an extra pair of absolutely sterile gloves on 
hand, at the moment for actual delivery the first 
pair can be discarded for the fresh pair. The use 
of rubber gloves should in nowise diminish the 
care with which the hands are scrubbed before 
putting them on. These precautions are the 
greatest insurance against the possibility of 
child-bed fever or other infection. 

ARTICLES NEEDED 

The following articles are needed for confine- 
ment and should be ready for use three weeks 
before the expected date : 
6 Sterile bed-sheets. 
12 Sterile hand towels. 
6 Pads, one yard square. 

1 Piece of rubber sheeting or table oil-cloth 
long enough to stretch across the bed and 
tuck in, and iy 2 yards wide. 
3 Abdominal binders, l 1 /^ yards long by y 2 yard 
wide. 

1 25-yard package of sterile gauze. 

2 One-pound packages of sterile absorbent 

cotton. 

1 Package or one yard of umbilical tape. 

1 Six-ounce bottle tincture of green soap. 

1 Jar sterile vaseline. 

1 Quart of boric acid solution in a glass stop- 
pered bottle. 



98 MATERNITY AND CHILD CARE 

1 Bottle of Lysol. 

1 Bottle of bichloride tablets (blue), labeled 
poison. 

1 Ounce of one per cent solution of silver 
nitrate. 

1 Six-ounce package of boric acid powder or 
Dermatol powder. 

1 One-half-pound package of boracic acid crys- 
tals. 

1 Two-ounce bottle of tincture of iodine. 

1 Three-ounce bottle tincture of benzoin com- 
pound. 

1 Pint bottle of alcohol, ninety-five per cent. 

1 Three-ounce bottle of fluid extract of ergot. 

2 Pairs of surgeon's rubber gloves . 
2 Nail brushes. 

2 Small camel hair brushes. 
2 Eye droppers. 

1 Two or four-quart fountain syringe. 

2 Glass douche tips. 
1 Douche pan. 

3 Porcelain or white-enamel medium size wash 

basins. 
1 Water pitcher. 
1 Large pail for waste. 

Sterilizing the Articles. — Of the two methods 
of home sterilizing, dry heat and steam or moist 
heat, the latter method is better. 

Towels, sheets and pads should be tied into 
small bundles by being wrapped in squares of 



PREPARING FOR CONFINEMENT 99 

clean unbleached or old muslin and pinned. To 
sterilize by steam or moist heat, take the wash 
boiler and suspend inside like a hammock from 
handle to handle a strip of muslin a little nar- 
rower than the width of the boiler. Below this 
hammock of muslin have two or three inches of 
water in the bottom of the boiler. Place the 
bundles in the hammock, cover the boiler and 
let the water boil briskly for an hour. The hot 
steam penetrates the bundles and sterilizes the 
contents. After the steaming, place the bundles 
in a wire drain suspended somewhere in a place 
where they will safely dry out and when thor- 
oughly dry pin the sterile supplies in a clean 
sheet that has been thoroughly boiled and put 
away ready for use. 

To sterilize by dry heat, put the wrapped bun- 
dles in a thoroughly clean pan in a slow oven 
and leave them there until the covering is 
scorched a light russet brown. Nail brushes and 
scissors should be boiled in a basin during labor 
and not taken from the water until used. Any 
instruments the doctor uses should be boiled in 
a separate basin. The surgeon's rubber gloves 
should be boiled in a basin and left in the water 
so that the physician can readily slip them on 
his hands in the sterile water, when the moment 
comes. 

Uses of the Articles. — The sterile sheets are 
not to be used on the bed until labor begins. The 



100 MATERNITY AND CHILD CARE 

sterile towels are for the doctor's and nurse's 
hands. The six pads, made of cheese cloth and 
filled with cotton batton, are used one by one 
under the patient during labor, being removed 
as soon as soiled. The rubber sheeting or oil- 
cloth is stretched across the bed under the sterile 
sheets to protect the mattress. Abdominal bind- 
ers are used after birth. The sterile gauze is 
used for dressing the navel cord and is also used 
with folds of the cotton in making the napkins 
which fasten to the binders. The sterile cotton 
is also used as sponges or pledgets. The umbili- 
cal tape used for tying the cord can be bought 
in jars or packages, or you can purchase the 
narrow cotton tape one-eighth inch or less in 
width and sterilize it with the other articles. 

The tincture of green soap and the nail brushes 
are used for scrubbing the hands of the doctor 
and nurse. Vaseline is used for lubrication and 
about the mother's nose and mouth if chloroform 
is given. The Lysol is the antiseptic used in 
rinsing the hands after scrubbing and is also 
used in the douche bag for irrigating the exter- 
nal parts. During labor a one per cent lysol 
solution should be kept ready for use in two 
basins, one in which the doctor rinses his hands 
can also contain the cotton that he uses as 
sponges. The other is to hold the instruments 
after they have been boiled. 

The bichloride tablets are used as directed, 



PREPARING FOR CONFINEMENT 101 

with the water in a porcelain bath-tub, or other 
container not tin or tin lined. This is for im- 
mersing the basins, pitcher, douche pan and 
syringe to sterilize them just before use. The 
directions on the tablets tell how many tablets 
are to be used in water to make a one to five 
thousand solution. 

Tincture of iodine is used by the doctor in 
sterilizing his finger nails after scrubbing his 
hands. He can do this with a sterile swab of 
cotton on a tooth-pick or dip his fingers into the 
iodine. After the cord is cut the stump is painted 
with the iodine solution used on a swab of sterile 
cotton. The one per cent solution of silver 
nitrate is to be used in the baby's eyes imme- 
diately after birth. One drop is put in each eye 
by the eye-dropper. Boric acid solution is made 
by putting one level teaspoonful of the crystals 
into each pint of boiling water and this is kept 
in the glass-stoppered bottle ready for use. A 
quart should be made up. It is used to wash out 
the baby's eyes a few seconds after the silver 
nitrate has been dropped in, and also for cleans- 
ing the mother's nipples before each nursing*. 

The alcohol is used whenever needed in vari- 
ous ways, in washing off the scissors or brashes, 
the doctor's hands and later in an alcohol rub 
for the mother. The boric acid or dermatol 
powder is used for dressing the navel cord. The 
ergot is given by the physician to the mother 



102 MATERNITY AND CHILD CARE 

as soon as the uterus is completely empty, the 
first dose usually being one teaspoonful. This 
is used to contract the uterus and prevent hemor- 
rhage. The tincture of benzoin is applied to 
the mother's nipples if they become cracked 
or sore after delivery. It is painted on with 
the camel hair brushes, then washed off just be- 
fore nursing with boric acid solution on sterile 
cotton swabs. The fountain syringe and glass 
tips are used in giving a douche to cleanse the 
external parts before and after labor. The 
douche pan is used for the douche and also as a 
bed-pan while the mother is in bed. 

PREPARING THE ROOM 

The room in which you expect to be confined 
should be clean, light and well ventilated. The 
furniture should be limited to necessities. The 
bed, two or three chairs, one table for dressings 
and another for wash basin, pitcher and towels. 
There should be no needless hangings or pictures 
to collect dust. Around the bed the carpet should 
be covered with several layers of newspapers and 
over these should be tacked a sheet. Before this 
the dust should be taken from the carpet by a 
wet cloth. 

The bed should stand out in the room so that 
the physician and nurse can pass on either side 
and it should face the light if possible. The mat- 
tress should be firm and smooth and not hollow 



PREPARING FOR CONFINEMENT 103 

or sagging in the middle. If the springs are not 
strong enough to keep the mattress level, place 
an ironing board or a table board beneath the 
springs. The single bed is best for confinement 
as, being narrower, it is easier for the physician 
to work about. 

Across the center of the bed and directly over 
the mattress stretch the rubber sheeting or oil- 
cloth. Tuck it well under the sides and fasten 
into the mattress by large safety pins to keep 
it from slipping. Over this place one sterile 
sheet, tucked in at all sides. Across the bed 
where the mother's hips rest place a sheet folded 
until it is about a yard wide and between the 
folds place several thicknesses of stout paper. 
This is a draw sheet which can be pulled out at 
the end of labor leaving the clean sheet below. 
Directly beneath the mother's hips are placed the 
sterile pads, used one by one and discarded as 
soiled. Over the mother is placed an unfolded 
sterile sheet. The night-gown should also be 
sterilized. 

Three or four weeks before confinement your 
physician should make an examination to see that 
the baby is in the proper position and that 
everything is progressing favorably toward the 
time of labor. He will talk with you about all 
preparations, see that you have properly steril- 
ized everything needed and he will leave instruc- 
tions as to when you are to notify him. 



104 MATERNITY AND CHILD CARE 

THE BABY'S FIBST CLOTHES 

Layette Designed by Mary A. Bartley, Collegiate and 
Polytechnic Institute, Brooklyn, N. Y. 

In order that the delicate baby skin be not 
irritated the clothing should be soft and light; 
not only soft in surface but soft in texture as 
well. The material ought to be porous and not 
too heavy, in order that evaporation of perspira- 
tion and proper ventilation of the skin may take 
place. 

Simplicity should be the keynote of the baby's 
wardrobe. The clothing should be simply made 
and the whole arrangement as simple as possible. 
Every unnecessary garment renders the exertion 
of being dressed and the burden of the clothes 
that much greater. 

Most important of all, the baby's clothing must 
be warm, for during infancy particularly, chil- 
dren are unable to resist the effects of cold. Gar- 
ments which are loose and those made of mate- 
rial of loose textures are warmer than others 
on account of the air which they retain in their 
folds, for air is a very poor conductor of heat. 
Wool is the material which best answers all these 
requirements, and with the exception of the dia- 
pers, all the clothing which comes next to the 
skin should be made at least partly of wool. 

There are some objections to the all-wool gar- 
ment, however. First, it has a great tendency 
to shrink and in so doing becomes very harsh 



PREPARING FOR CONFINEMENT 105 

and tight and proves very irritating to the skin, 
especially in hot weather. So instead of the all- 
wool garment, the cotton and wool or the silk 
and wool fabrics could be used. In the very 
warmest weather, thin cotton or silk and cotton 
garments may be worn. 

The band consists of a straight piece of flannel, 
all-wool or silk-and-wool, pinked or bound around 
the edge and tied with flat knots of uncurlable 
tape. This garment may also be knitted or cro- 
cheted and could be easily made at home. It 
should be wide enough to extend from the hips 
well over the ribs and should be about six inches 
in width. It may also be made with shoulder 
straps and little tabs in front and back to which 
the diaper may be pinned. Four of these bands 
are needed. 

The diapers should be made of soft light ab- 
sorbent materials. Linen and cotton diaper 
cloths are the best, each having its advantages. 
Linen is cooler and less bulky, while cotton is 
absorbent. Canton flannel should not be used 
as it is too little absorbent and soon becomes 
harsh with laundering. The diapers for the 
early months of life should be one yard long by 
one-half yard wide, increasing in size as the 
child grows. 

The Vanta diaper, which has a dart taken in 
the back to give shape and which may be tied 
with non-curlable tape, may be purchased in the 



106 MATERNITY AND CHILD CARE 

shops, as may also the Arnold diaper, that also 
has the dart in the back but with which pins are 
used. From four to six dozen are needed. 

The shirts must be made of combination silk 
and wool, because of warmth and for laundry 
purposes. They may be double-breasted and tied 
with non-curlable tape, or may be button-holed 
down the front. They should have high neck 
and long sleeves and should reach well below the 
hips. From four to six are needed, but not less 
than four. 

The socks should be crocheted or knitted of 
silk thread or very soft yarn and should reach 
half way to the knee or higher. Six pairs are 
needed. 

The night gowns are commonly made of cotton 
stockinet with a drawstring at the neck and 
sleeves and hem, or they may be closed at the 
bottom with a long opening in the back. For 
summer this garment is usually made of muslin, 
thin outing flannel, cambric, or nainsook. From 
four to six are needed, but not less than four. 

The best material for the petticoat is white 
flannel. This may be made in one piece, buttoned 
on the shoulders and bound around the neck and 
armholes, or it may consist of a straight full 
skirt of flannel gathered to a straight muslin 
band which laps over in the front and is pinned. 
For warm weather this garment may be made of 
lawn, batiste, nainsook, and fine linen is often 



PREPARING FOR CONFINEMENT 107 

used. Four flannel and four cambric petticoats 
are needed. 

The dress is usually made of nainsook, lawn or 
batiste, tucks or gathers are used for fullness, 
with inverted plaits under the arms which throw 
fullness across the waist. The length of the 
dress should not be more than twenty-six inches. 
Six are needed. 

In winter there is needed a long very warm 
cloak of some woolen material such as cashmere, 
serge or muslin with a quilted lining; also a 
warm, thick, lined cap or hood covering the ears. 
For summer the coat is made of light weight 
material without the quilted lining, or of pique, 
and the cap of silk or thin muslin. Mittens of 
silk or silk-and-wool are needed for the winter 
months. 

There should also be a warm shawl or shoulder 
blanket made of very soft flannel, which can be 
thrown about the baby and over its head when 
carried about the room. Two of these are needed. 

A list of articles needed is as follows: 

Bands 4 

Diapers 4 to 6 dozen 

Shirts 4 to 6 (preferably 6) 

Socks 6 pairs 

Night Gowns .4 to 6 (preferably 6) 

Petticoats 4 flannel 

Petticoats 4 cambric 



108 MATERNITY AND CHILD CARE 

Dresses 6 

Coat 1 (winter) 

Coat 1 (summer) 

Hood 1 (winter) 

Caps 2 (summer) 

Mittens 2 pairs 

Shoulder Blankets 2 



CHAPTER XI 
THE BIRTH OF THE BABY 

Two or three weeks before the date of confine- 
ment, the womb drops by a process commonly 
called "settling." The fetus sinks lower into 
the pelvis. The prospective mother usually feels 
more comfortable because breathing becomes 
easier. The settling, however, brings pressure 
to bear on the nerves passing to the lower limbs 
and the mother experiences a cramping sensation 
in her legs. The settling uterus once more 
presses upon the bladder causing frequent uri- 
nation as in the early months. 

The beginning of labor may be heralded by 
three different signs. The most common is pain, 
regular and recurring. Another sign, which may 
precede the pain, is a sudden gush of water. An- 
other, less frequent sign, is a bloody discharge. 

Labor Pains. — The sensation of pain usually 
comes in the back or lower abdomen. At first 
this is slight, recurring after hour or half -hour 
intervals of rest. These pains may be mistaken 
for colic. They soon increase in strength and 
frequency if true labor pains. When they ap- 
pear regularly every thirty or forty minutes and 

109 



110 MATERNITY AND CHILD CARE 

last for a few seconds, and when at the time of 
pain the abdomen feels tense or hard underneath 
the hand, they are true signs of approaching 
labor and your doctor* must be notified at once. 

There will be times when you are in doubt re- 
garding these pains because it is not uncommon 
to have preliminary or " false pains' ' two or 
three weeks before labor. These are irregular 
and may cease entirely, or, when they make their 
appearance close to the time of labor, they may 
pass directly into true labor pains which then 
become of the regular character. 

Vaginal Discharge. — During the latter months 
of pregnancy there is almost always a consider- 
able discharge of mucous from the vagina. This 
is of no special significance and is often mis- 
taken for a leucorrhoea. As the time of labor 
approaches there may occur a sudden gush of 
water from the vagina which is due to an early 
rupture of "the bag of waters" and should be 
interpreted as a sign of approaching labor. This 
rupture is usually followed within a very short 
time by the regular labor pains. In rare in- 
stances the bloody discharge is the first sign 
of labor and this may be quite profuse. It is 
commonly followed promptly by the regular labor 
pains. 

The First Preparations. — If you are fortu- 
nate enough to avail yourself of hospital care 
these first preparations will all be directed for 



THE BIRTH OF THE BABY 111 

yon after you reach the hospital. In case yon 
are employing a trained nnrse she will have 
reached yonr home by this time and will person- 
ally take charge of these details. Left alone the 
first thing is to take a good soap-suds enema as 
soon as you decide from the symptoms that the 
time of labor is near. It is of utmost impor- 
tance that the lower bowel be thoroughly clean. 

Next take a warm bath, scrubbing the entire 
body well with soap and water, giving especial 
attention to a thorough scrubbing around the 
genitals. In hospital confinements the genitals 
are shaved. For the home confinement it is well 
to clip the hair. 

If you are going to the hospital you will have 
engaged your room long before the date of con- 
finement, and it is not necessary to start for the 
hospital until definite signs of the onset of labor, 
such as pains coming at regular thirty or forty 
minute intervals, the rupture of the "bag of 
waters" or the bloody discharge. If the trip 
to the hospital requires an hour and a half to 
two hours, or if the mother is nervous, she should 
go there two or three days before the date of 
her expected confinement. Everything to be 
taken to the hospital should be packed a few 
days before the expected date. 

The only hospital requirements are the night- 
gowns, bathrobe or dressing gown and slippers 
and something to throw over the shoulders when 



112 MATERNITY AND CHILD CARE 

sitting up in bed. All of the surgical dressings 
and medicines used before and after labor are 
supplied by the hospital. In addition take the 
clothing needed by the baby for the first three 
weeks as no clothing for the baby is supplied 
by the hospital. 

LABOE 

As the pains become more severe they begin 
to appear at regular intervals. The intensity 
increases and the intervals shorten until they 
come every three to five minutes, and when the 
time for expulsion of the fetus is near the pains 
come every minute or half minute. 

The process of labor is divided into three 
stages. The first stage that is by far the longest, 
includes the whole process by which the birth 
canal is gotten ready. The second stage is the 
actual passing of the baby through the birth 
canal into the world. The third stage is the time 
which deals with the passage of the placenta or 
after-birth. 

First Stage. — During the first stage, your phy- 
sician will find it necessary to make one or more 
examinations to determine whether the uterus 
is fully dilated and the head properly presented. 
A careful physician makes as few of these as he 
safely can, realizing the danger of carrying in 
some infection on his hands or from around the 
vagina. The number of examinations necessary 



THE BIRTH OF THE BABY 113 

may be only two and in other cases ten or more. 

As the pains progress the month of the womb 
begins to dilate. This is brought about by the 
muscles of the body of the womb as they con- 
tract and pull away from the mouth to open it, 
and also by the "bag of waters' ' or amniotic 
fluid which is being pushed as a wedge into the 
mouth of the womb. 

At times this "bag of waters'' ruptures in the 
very beginning. Again it may rupture soon after 
labor has started, part of it coming away with 
a gush and the remainder dribbling away during 
the entire process of labor. When this happens 
we have what is known as a "dry birth/ J Usually 
the "bag of waters " remains intact as a wedge 
until the mouth of the womb is entirely dilated 
and then ruptures, expelling all of the water at 
once. 

During the first stage of labor, the patient as 
a rule is quite comfortable between pains and 
may rest or walk about as she pleases. When 
the pains or contractions of the uterus appear, 
do not strain or try to bear down but allow them 
to proceed normally. If you are walking about 
when the pains come on it is good plan to sup- 
port yourself by a chair or at the foot of the bed 
while they last. As the baby's head presses 
down you will feel a frequent desire to have a 
movement of the bowels and to urinate. This 
is simply caused by the pressure. 



114 MATERNITY AND CHILD CARE 

During the first stage there is no reason why 
you should not drink a little coffee or hot milk 
or gruel. Don't take any solid food, because 
later the physician may decide to give you a lit- 
tle chloroform and it is then better not to have 
any solid food in the stomach. Furthermore, 
during the end of the second stage just before 
the baby is delivered, mothers frequently experi- 
ence a desire to vomit and if there is solid food 
in the stomach it makes this feeling worse. 

Second Stage. — After the mouth of the womb 
has become completely dilated, preceded as it 
usually is by the rupture of the "bag of waters," 
there commonly occurs a considerable discharge 
of blood. At times this is not present at all. 
The mother will feel a desire to bear down and 
this she can safely do, even assisting by pulling 
on a sheet tied to the foot of the bed with her 
feet braced against something solid, bearing down 
only during the pains. As the pains grow more 
severe and frequent the patient feels the head 
of the fetus pushing downward into the vagina 
and the time of actual delivery rapidly ap- 
proaches. It is at this time in labor that choloro- 
form in small amounts is commonly given to re- 
lieve some of the pain. As long as the mother 
is organically sound there is no reasonable ob- 
jection to its use. The chloroform must never 
be used at the beginning or during the first stage 
of labor unless actual operation is necessary. 



THE BIRTH OF THE BABY 115 

But after the mouth of the womb is dilated and 
the head of the child is pressing down into the 
vagina, small whiffs of chloroform given just 
as the mother feels a pain starting and con- 
tinued while the pain lasts, will greatly relieve 
her. Not enough is given so that she loses entire 
consciousness, and giving the chloroform at this 
time does not lessen the contraction of the uterus. 
Between pains the chloroform mask is usually 
taken away or is held so that the mother only 
gets a very small amount. Chloroform must 
never be administered unless a physician is pres- 
ent to personally direct its use. 

As the pains increase, the top of the baby's 
head appears and as it passes through the out- 
let it is rotated upward and the full face comes 
into view. There is usually a short rest and 
then the remainder of the body is expelled, fol- 
lowed by a sharp gush of blood and water. 

Third Stage. — Following the delivery of the 
baby there are several minutes of rest. It is 
not a practice to tie off the umbilical cord at 
once. Some blood is being pumped through it 
even after the baby has reached the outer world. 
However, in a few seconds the pulsation in the 
cord ceases, and about an inch and a half or 
two inches from the baby's body the umbilical 
tape is passed once or twice around the cord 
and firmly and securely tied in a hard knot. 
At a point about two inches beyond this, toward 



116 MATERNITY AND CHILD CARE 

the placeta, the umbilical tape is again firmly 
tied about the cord and with the sharp scissors 
the cord is severed between these two places 
that have been tied. 

As soon as the baby is born, the physician 
immediately inspects the perineum to see if 
any tears have occurred. This is of utmost 
importance and should always be insisted upon 
because tears of the perineum allowed to go 
unrepaired result in all forms of pelvic displace- 
ments and are responsible for much invalidism. 

It is very easy to give the mother just a 
little more chloroform (or a complete anes- 
thetic if needed), make her momentarily insen- 
sible to pain, and put in one, two or three 
stitches as may be found necessary. These 
stitches properly taken, correctly bring together 
the raw edges which will have completely and 
solidly healed by the time the mother is able to 
be out of bed. 

As soon as the baby is expelled the uterus 
becomes much smaller and harder and after a 
period ranging from ten to thirty minutes, pains 
will again appear and the placenta will be 
expelled. This may take several minutes. Very 
commonly physicians do not wait for Nature 
to accomplish this process, but from outside, 
through the relaxed abdominal wall, they grasp 
the uterus firmly in one hand and by forcible 
downward pressure expel the placenta. The 



, 



THE BIRTH OF THE BABY 117 

expulsion of the placenta is followed by a great 
gush of blood. 

As a rule the physician or nurse keeps a hand 
over the uterus through the flabby abdominal 
wall, keeping up a gentle squeezing or massage- 
like pressure over the uterus. This helps the 
uterus to contract and also prevents serious 
hemorrhage from occurring. The right hand of 
the nurse or doctor is used to keep up this 
pressure and it should be continued for several 
minutes until the uterus feels hard and firm. 
If the uterus, under the hands, shows any tend- 
ency of relaxing, it may be necessary to keep 
up this pressure thirty or forty minutes or 
even longer. 

If the mother has not been put completely 
under the influence of chloroform, just as soon 
as the placenta is expelled the physician orders 
one teaspoonful of the fluid extract of ergot to 
be given in a little water. This helps to con- 
tract the uterus and prevents hemorrhage. Many 
physicians prefer to use for the first dose of 
ergot a hypodermic of some sterile ergot prep- 
eration. This method has an advantage over 
the other as the ergot gets into the blood more 
quickly. If the mother has had an anesthetic 
she cannot immediately take it by the mouth. 

While the uterus is being held through the 
abdominal wall to help its contraction, some one 
in attendance with thoroughly sterile hands 



118 MATERNITY AND CHILD CARE 

and sponges of sterile absorbent cotton dipped 
in the lysol solution, cleans away all of the 
blood from the thighs and external parts, always 
sponging from above downward. The great 
danger of sponging from below upward is the 
wiping of any fecal matter or contamination into 
the vagina. The draw sheet is then pulled out. 
A napkin of folded sterile gauze between the 
layers of which is laid a thick padding of sterile 
cotton, is placed over the external parts. The 
uterus now being well contracted the abdominal 
band is firmly pinned on, pinning from above 
downward so as to exert the greatest pressure 
over the top of the uterus. The sterile napkin 
is pinned to the binder and the patient is 
covered with clean sheets and warm blankets. 
A hot water bag is put at the feet because there 
is often a feeling of chilliness immediately after 
the baby is born. The room is darkened and 
the patient is then usually able to take a much 
needed nap. 

The Use of Forceps. — In some cases there 
will be times when your physician may deem 
it necessary to use obstetrical forceps. Stories 
you hear about the dire results that might 
come to the baby through the use of forceps are 
the product of imagination. If during labor, 
the physician listening through your abdomen 
finds that the baby's heart beats are becoming 
too rapid, indicating suffocation, it is necessary 



THE BIRTH OF THE BABY 110 

to hasten labor and get the baby into the open 
air as quickly as possible. Again, a mother 
may become exhausted from prolonged labor and 
the physician decides that it is wise to put on 
the forceps and greatly hasten delivery. There 
may be physical conditions in the mother which 
do not permit of long and hard labor and your 
physician's judgment as to using forceps at 
such a time must always be relied upon. 

Delivery Without Medical Help. — During the 
last four weeks of pregnancy the prospective 
mother should never be left alone. If she is 
compelled to undergo the ordeal of confinement 
without medical help, she should make all the 
preparations as though a physician were going 
to be present. It might happen that a physician 
engaged for a confinement would fail to arrive. 
As the symptoms show that labor is in progress, 
the companion of the prospective mother should 
have all the dressings ready by the bedside but 
should not open them until they are actually 
needed. 

Prepare the bed as already directed and have 
the two basins ready with the lysol solution. 
The companion should thoroughly scrub her 
hands with the green soap and water, using 
the nail brush to thoroughly scrub her nails 
and she should then paint tincture of iodine 
all around the nails. She should stand by tin 4 
bed without touching anything or attempting 



120 MATERNITY AND CHILD CARE 

to make any examination or interferring in any 
way with the progress of labor. 

As the mother feels the head pressing down 
on the vagina, accompanied by a desire to bear 
down, she can help by pulling on the sheet tied 
to the foot of the bed and with her feet braced 
against something solid. When the head is 
born, if the baby does not look blue, the attend- 
ant is still to let things alone because the re- 
mainder of the body will be expelled in a few 
seconds. When the head appears should the 
baby look blue or black in the face and about 
the head the attendant should grasp the head 
with one hand underneath the chin and the 
other over the back of the head and pull steadily 
downward with considerable force. The mother 
can also help at this time by putting her hands 
over the abdomen and pressing down against 
the top of the uterus which she can easily feel 
through the abdominal wall. 

Just as soon as the baby is born it will 
cry. If it does not, and does not appear to 
be breathing, grasp it by the legs and hold it 
up, the head hanging downward, and slap 
sharply across the back. This is to be done 
right away before the attendant tries to tie the 
cord. The baby usually begins to breathe 
promptly. Lay the baby down quickly between 
the mother's thighs and tie the cord in the way 
already directed. When you pick the baby up 



THE BIRTH OF THE BABY 121 

by its legs be careful not to pull the baby up 
so high that the cord will be stretched and 
broken. 

One thing the attendant must do as soon as 
the head appears is to notice whether the cord 
is twisted around the baby's neck. If so, she 
should slip one hand down around the baby's 
neck and grasp the cord between her thumb and 
finger. With the other hand pressed over the 
top of the head, she should hold the baby back 
and with gentle traction slide the cord over the 
baby's head, thus loosening it. This is im- 
portant because the cord can break in this posi- 
tion while the baby is being born, causing 
hemorrhage or strangulation. 

In fifteen to thirty minutes the placenta will 
be expelled. This is preceded by a few sharp 
contractions of the uterus. The attendant can 
help this by pressing downward on the top of 
the uterus through the abdominal wall when 
the pains appear. No one must ever pull on 
the umbilical cord. As soon as the placenta is 
expelled, the mother can be given a teaspoonful 
of the fluid extract of ergot. The attendant 
can cleanse the external parts with the sterile 
cotton sponges soaked in the lysol solution, 
remove the draw sheet and put on the sterile 
napkin and binder as already described. 

It is a splendid plan for the attendant to sit 
by the bed before putting on the binder and 



122 MATERNITY AND CHILD CARE 

firmly press on the uterus through the abdominal 
wall in the manner already described. 

Be sure to pin the binder on very snugly. 
A very good practice is to twist a sterile towel 
as you would a rope and place it in a cuplike 
shape on the abdomen directly over the top of 
the uterus, which will be just a little above the 
pelvic bone. Pin the band over this very 
tightly. The patient can then receive a cup of 
hot milk or broth and be warmly covered. 

In rare instances a baby is born in a posi- 
tioned termed breach presentment, the lower 
limbs being born first. In such a case, as the 
attendant stands beside the bed, she should 
quickly wring out a towel from very warm water 
(100° which is a little warmer than body tem- 
perature) and wrap it about the baby's legs and 
buttocks as they come into the world. Then with 
both hands on the outside of the mother's abdo- 
men, a few inches above the pelvic bone, press 
firmly and steadily downward in order to bring 
pressure over the top of the baby's head. The 
mother can also assist at this time by bearing 
down, pulling from the sheet tied to the foot of 
the bed. This hastens the birth of the head which 
is important. 

Immediate Care of the Baby. — There will be 
times when the baby does not begin to breathe 
immediately after it is expelled. The stimulat- 
ing effect of the air on the baby's skin will 



THE BIRTH OF THE BABY 123 

cause him to inhale quickly and fill the lungs 
with air. The baby usually utters a cry as 
soon as it is in the outer world, which is a 
very good indication that he is breathing. When 
the baby does not breathe at once it is usually 
due to mucous that has gotten into the throat. 
If the attendant will quickly wind a piece of 
gauze around her finger, open the baby's mouth 
and run the finger down the throat, she can 
quickly wipe away the mucous. She should 
then grasp the baby by the feet, holding him 
head downward, and slap him sharply across 
the back. This is usually all that is necessary. 

There will be times when the baby will not 
begin to breathe even after this procedure. A 
tub of warm water should be ready and re- 
membering that the cord has already been tied, 
you can plunge the baby into the warm water. 
Hold him with your hands behind his back and 
your fingers under his armpits, which holds 
the head out of the water. Move him about in 
the water for just a few seconds. A deep in- 
halation of air will ususually be taken as soon 
as the baby touches the water. 

In extreme cases, we find that dashing a 
little cold water on the baby's limbs and around 
his chest and abdomen, then plunging him 
back into the warm water, will cause prompt 
breathing. 

Never give up, because a baby may not show 



124 MATERNITY AND CHILD CARE 

signs of breathing for many minutes and still 
be revived. A practice resorted to in some 
hospitals in extreme cases is to quickly wrap 
the baby in a blanket and lay him over the 
side of a table with the head hanging over 
the edge face downward. He is then gently 
rolled from side to side, never rolling him 
clear over on his back, but up on one side and 
then up on the other side. This repeatedly has 
caused very badly asphixiated babies to breath 
within a few minutes. 

Twilight Sleep. — One word about twilight 
sleep ; it never should be used in the home. Even 
in the hospital, with all available skill at hand, 
its employment is attended with considerable 
danger, not only to the mother but to the 
unborn baby. After a most thorough trial in 
which it was used in several hundred cases in 
one of our largest maternity hospitals, its use 
was entirely abandoned, being declared unsafe 
and unreliable. 



CHAPTEE XII 

CARE DURING THE PUERPERIUM OR PERIOD 
AFTER LABOR 

The period immediately following labor, which 
lasts for six weeks or more until the uterus 
returns to its normal size, is known as the 
puerperium. 

As soon as labor is accomplished the mother 
is usually thirsty and after a few sips of water 
will fall asleep, waking much refreshed and with 
the skin moist with perspiration. She may 
have a distinct chill directly after delivery. 
This is of no significance if not associated with 
fever and promptly passes as she is made warm 
and comfortable. The smarting and burning 
pain in the external genitals will last for a 
time. 

After-pains. — Many times, painful contrac- 
tions of the uterus continue after the birth of 
the child. They are more common in subse- 
quent confinements than with the first child, 
and often appear only when the baby is put 
to the breast. They are probably many times 
due to the clots of blood or pieces of retained 
membrane which the uterus tries to expel. The 

125 



126 MATERNITY AND CHILD CARE 

practice of giving fluid extract of ergot four 
times a day for four or five days in order to 
keep the titerus well contracted to prevent hem- 
orrhage, is also beneficial in relieving these 
after-pains. When the pain is severe the physi- 
cian sometimes finds it necessary to give a 
sedative. 

Pulse and Temperature. — The pulse usually 
becomes much slower right after delivery with 
a corresponding rise of temperature of half a 
degree or slightly more. Both temperature and 
pulse should return to normal by the end of 
thirty-six hours. A more serious rise of tem- 
perature is discussed later in this chapter. 

Respiration and Shin. — The breathing is 
slightly slower than normal and the skin throws 
out a great deal of perspiration during the 
first week so that the mother should be warmly 
covered and the bed kept out of a draught. 
The daily warm sponge bath should be given 
in bed. 

Stomachy Kidneys and Bowels. — For the first 
two or three days, until the milk comes, there 
is little desire for food. The kidneys become 
very active for the first twelve or twenty-four 
hours although urine may not be passed, the 
bladder being able to retain large quantities at 
this time. Albumin is often found in the urine 
after labor but this is of no significance if the 
kidneys were all right previously, and if it 



CARE DURING THE PUERPERIUM 127 

disappears within three or four days. Because 
great pressure has been suddenly taken from the 
bowel, it may remain dormant until a cathartic 
is given. Inasmuch as the bowel was well 
emptied before confinement and little or no 
food taken soon after, there is only a slight 
residue. 

Weight. — With the delivery of the baby there 
is a sharp loss of weight. This loss is enhanced 
by a free excretion from all the organs and 
by the slight amount of food taken during the 
first days. This loss is regained by the seventh 
or eighth week and there is a return to the 
normal weight as before pregnancy. Very deli- 
cate mothers and those who do not nurse their 
babies may not entirely regain this weight. 

The Nervous System. — After delivery the 
mother is prone to be nervous and irritable and 
this is emphasized by the after-pains, by the 
attempts of the baby to nurse, or by any out- 
side disturbances. As this may result in a 
rise of temperature, all excitement should be 
prevented. 

EARLY MANAGEMENT 

The management of the mother during this 
period divides itself into two important heads; 
cleanliness and rest. The physician should re- 
main with the mother an hour or more after 
delivery to see that everything is progressing 



128 MATERNITY AND CHILD CARE 

favorably and that she is as comfortable as 
possible. The external genitals have been 
cleansed, the binder put on, the sterile napkin 
adjusted and the bed and night-clothing made 
cleJan. He will caution the mother to lie quietly 
on her back with her head low, because raising 
it too high on pillows immediately after labor 
may result in dizziness. 

Internal douches are not given unless a high 
temperature develops with foul-smelling lochia. 
The genitals are kept clean by an external 
douche. The bedding must be thoroughly clean 
and the lying-in room carefully ventilated. 

As soon as the placenta is expelled the physi- 
cian gives the ergot. This treatment should 
never be omitted. After the mother's first hour 
of rest another half teaspoonful should be given 
and followed for the next five or six days by 
a half teaspoonful four times daily. The firm 
contraction of the uterus is an important safe- 
guard against the development of child-bed 
fever, or puerpal sepsis. 

For several days following labor there will be 
a moderate bloody discharge from the vagina. 
This gradually grows paler in color and dis- 
appears. This is called the lochia and when 
everything is progressing favorably should have 
no foul odor. A disagreeable odor at once 
suggests the possibility of a piece of the placenta 
having been retained in the uterus, or of an 



CARE DURING THE PUERPERIUM 129 

infection which has gained entrance at the time 
of labor. If accompanied by other symptoms 
such as chills and high fever, this calls for 
immediate attention. 

One thing that should always be secured is 
a good clinical thermometer with which to keep 
a record of your temperature. A little rise 
right after labor is not uncommon, but a rise 
of temperature after thirty-six hours may be 
a sign of infection and the forerunner of child- 
bed fever. On the other hand, a rise of tem- 
perature may be due to constipation, or to the 
coming of the milk, especially when the breasts 
are very tense, or to sore nipples and to any- 
thing that may excite or worry the mother. 
But when the fever comes preceeded by a chill, 
when the lochia begins to have a foul odor, 
and when the mother is greatly prostrated with 
headache, dry mouth, and a temperature show- 
ing rapid rise and fall; these signs of child-bed 
fever call for immediate attention. If the foul 
odor of the lochia is not accompanied by these 
other symptoms, the piece of retained placenta 
or membrane may be thrown off spontaneously, 
if not the physician may find its removal 
necessary. 

When child-bed fever develops the mother 
should remain in bed quietly. Until medical help 
can be obtained have your attendant or nurse 
give one-half teaspoonful of ergot in water every 



130 MATERNITY AND CHILD CARE 

three hours and place an ice-bag or cold applica- 
tions low down over the abdomen. Give an 
absolutely sterile douche as hot as can be borne, 
proceeding as follows: The douche bag and 
douche point, the latter preferably of glass, must 
be sterilized by boiling. Use a two-quart douche 
made of water which has been boiled and con- 
taining one teaspoonful of lysol (one-half tea- 
spoonful to the quart). Take this while lying 
flat on the back, using the douche pan in bed, 
two or three times during the day. The bowels 
must be promptly and completely emptied by 
a dose of castor oil or Epsom salts. The diet 
must be semi-liquid, consisting of broths, soups, 
milk, soft eggs and custard, with nothing solid. 
Follow this advice until your physician arrives 
and see that he comes as quickly as possible. 

Hemorrhage. — If at any time during the course 
of your recovery you should suddenly start to 
flow very freely, send for your physician imme- 
diately and until he arrives lie flat en your 
back in bed. Remove the pillow and have the 
foot of the bed elevated two feet on blocks or 
chairs so that your blood flows toward the 
head instead of toward the feet. Take at once 
one teaspoonful of the fluid extract of ergot. 
Keep perfectly quiet, do not attempt to get 
on your feet. When your physician comes he 
may find it necessary to tightly pack the vagina 
with sterile gauze. He will advise you to keep 



CARE DURING THE PUERPERIUM 1S1 

off your feet for a number of days until all 
flowing has ceased with no further evidence of 
it for several days. 

Care of External Genitals, — The napkin put 
on after delivery should always be of sterile 
gauze, and between its layers should be sterile 
absorbent cotton. This is important because all 
the lochia! discharge must be absorbed in the 
napkin and not allowed to accumulate in the 
folds of the skin. The external genitals should 
be cleansed every six hours and a fresh napkin 
put on. For this cleansing use a lysol solu- 
tion made by putting one teaspoonful of lysol 
in a quart of water which has been boiled. 
Use it warm in the douche bag and irrigate the 
external parts. Have perfectly clean hands and 
make no attempt to separate the lips or to 
give an internal douche unless special indica- 
tions arise, such indications as were spoken of in 
connection with child-bed fever and foul-smelling 
lochia. 

While irrigating the genitals, sponge the folds 
of the skin around the vulva and inside the 
thighs with a sterile piece of gauze, remembering 
to wash from above downward. Cleansing can 
be done with the sponges of sterile gauze dipped 
in the lysol solution in a bowl instead of with 
the douche. It is necessary to observe strict 
care and cleanliness for there are always some 
abrasions in the genitals after child-birth and 



132 MATERNITY AND CHILD CARE 

these may easily become the starting point of 
an infection. 

REST AND EXERCISE 

Next to cleanliness the most vital part of 
the after-care is rest. The effect of the ex- 
haustion of labor upon the nervous system is 
serious. All the ligaments and muscles of the 
pelvic organs have been greatly stretched and 
must return to their normal tone and strength 
to avoid permanent and disabling pelvic mis- 
placements. All this can be brought about only 
through a sufficient period of rest. Failure to 
nurse the baby is oftentimes due solely to the 
mother's attempt to be on her feet and assume 
her household duties before her physical and 
nervous systems have recovered from the shock 
and strain of childbirth. A mother often re- 
mains nervous and exhausted for a long period. 
She is frequently told that this is of little 
consequence and that as soon as she becomes 
active she will feel all right and her usual 
health will be re-established. This can only 
be true when she takes the right amount of rest. 

There are certain glands in the body which 
throw out internal secretions and when these 
glands are thrown out of balance ill-health re- 
sults. These glands secrete normally only when 
the body receives sufficient rest and sleep. After 
confinement not only is extra rest needed but 



CARE DURING THE PUERPERIUM 133 

oftentimes medicines as well. There should be 
no return to the routine work for some time. 
It is essential to have ten days or two weeks' 
rest in bed without visitors except for the 
members of the immediate family who realize 
the importance of quiet and freedom from all 
anxiety. AH disturbances, even the care and 
crying of the new baby, should be removed as 
far as possible 

At the end of the week if everything has 
gone well the mother can be propped up in 
bed by pillows. At the end of two weeks or 
at the beginning of the third, she can begin to 
sit up a. little in a chair each day, also to take 
a few steps, remaining up a little longer each 
time. When the mother sits up and if the 
weather permits, it is a splendid plan to get 
her outdoors for a little time each day. By 
the end of the fifth day she can be turned on 
her side, and it is then a good plan for her 
to lie face downward for an hour in the fore- 
noon and an hour in the afternoon. This should 
be continued, increasing the time, for the entire 
period she remains in bed. After the first 
week she can try to sleep on her side or 
abdomen. This offsets the tendency of the 
uterus to tip backward from the constant lying 
flat on the back. 

While the mother is resting she must be given 
her daily warm sponge bath, must have her 



134 MATERNITY AND CHILD CARE 

teeth cleansed regularly and her bedding and 
night clothes kept scrupulously clean. When 
she is able to be out of bed at the end Of two 
weeks, she should be given a daily warm salt 
tub-bath. Sea salt should be used, or, if that 
is not available, use table salt, a level table- 
spoonful to each gallon of water. The brine bath 
aids circulation and has a very refreshing and 
stimulating effect. 

After the fourteenth day, if the mother has 
gotten along without any set-backs, it is a 
splendid plan, while lying in bed, to take the 
following exercise to strengthen the abdominal 
muscles: Lie flat with the limbs straight and 
the heels held down, rise slowly to a sitting 
position without using the arms. This exercise 
can be taken two or three times during the 
day, raising just once to begin with and grad- 
ually increasing the exercise so that by the 
fourth or fifth week she is able to raise herself 
to a sitting position ten or twelve times twice 
a day. This tones the flabby abdominal muscles. 

The abdominal binder is worn snugly pinned 
all of this time. It should be wide enough to 
reach from well over the hips to the ribs. As 
soon as the mother gets on her feet she should 
have a good support for the abdomen and should 
at once put on a good corset and wear it all 
the time she is out of bed, putting it on before 
standing on her feet. 



CARE DURING THE PUERPERIUM 135 

LATER CARE 

Care of the Bowels. — Forty-eight hours after 
delivery the usual procedure is to give one-half 
to one ounce of castor oil or if the mother 
cannot take this, compound licorice powder or 
fluid extract of cascara. This is essential in 
order that all waste matter be swept out of 
the intestines. While remaining in bed and 
inactive, it is usually necessary each night to 
give a cathartic of licorice powder or a cascara 
pill. Even a slight amount of constipation, 
if allowed to persist, may cause a rise of 
temperature. 

Care of the Bladder. — It is not uncommon to 
be unable to pass urine right after delivery. 
The patient may be allowed to go twelve hours 
but after this every effort should be made to 
urinate without the use of a catheter. Hot 
cloths laid over the lower part of the abdomen; 
gentle pressure over the bladder, either with 
the hand or by pinning the binder tighter; the 
sound of running water are some of the mea- 
sures used. If these do not succeed it is neces- 
sary to use the catheter. The hands of the 
nurse or attendant, or physician must be per- 
fectly clean, the glass catheter sterilized by 
boiling, and the region around the meatus 
cleansed with boric acid solution before attempt- 
ing to insert the catheter. This is only done 



136 MATERNITY AND CHILD CARE 

when the other measures fail as there is danger 
of infecting the bladder and producing a chronic 
intractable inflamation of that organ, known as 
cystitis. After the third or fourth day, if there 
is still difficulty in urinating, the mother can be 
carefully raised in bed to an upright position on 
the bed pan. If this makes her faint or dizzy 
it must be discontinued. If she will accustom 
herself to the use of the bed-pan for urinating 
during pregnancy just before the time of con- 
finement, she will rarely have this trouble 
afterward. 

Care of the Breasts. — As soon as the mother 
has been made comfortable, usually by the latter 
part of the first or early on the second day, 
the baby is put to the breast. It is better to 
begin this early, even though there is no milk 
for the first two or three days, because it 
establishes the habit of nursing in the baby 
and is one of the greatest aids in stimulating 
the uterus to contract and the pelvic organs to 
return to normal. The act of nursing also 
greatly stimulates the secretion of milk. 

If you follow the instructions given for the 
care of the breasts during the later months of 
pregnancy, daily sponging the nipples with the 
saturated solution of boric acid and alcohol, 
they will usually give you little trouble after- 
ward. Before each nursing the nipples should 
be gently sponged off with the saturated solu- 



CARE DURING THE PUERPERIUM 137 

tion of boric acid on a piece oi sterile cotton 
or gauze. It is not now necessary to use the 
alcohol which was employed before to harden 
the nipples and to prevent cracking. If any 
cracks or fissures appear during nursing, making 
the nipples painful, paint them with compound 
tincture of benzoin on a camel's hair brush 
which has been sterilized by boiling. Each 
time before nursing sponge off the benzoin with 
warm boric acid solution. This is important 
because an infection can readily gain entrance 
to the breast through cracks and fissures. If a 
tender or painful spot appears on the breast 
and you have temperature, do not allow the 
baby to nurse from that breast and notify your 
physician at once. It means that an infection 
has gotten in and that there is danger of 
abscess. This, with inflammation, caking, and 
other conditions, is discussed in the volume, 
The Proper Feeding of Infants and in the chap- 
ter, Making Maternal Nursing Successful. 

When the milk comes into the breasts they 
sometimes fill very rapidly and become greatly 
distended and painful. The amount of milk 
drawn off by the baby may not be sufficient to 
relieve this. A good plan is to have the attend- 
ant, with perfectly clean hands, massage the 
breasts, then take a warm cloth, preferably 
flannel, which has been sterilized in the oven, 
and place this over one breast at a time, gently 



138 MATERNITY AND CHILD CARE 

pressing the milk into the flannel. Some of 
the milk could be drawn off by the breast- 
pump but this is stimulating and only promotes 
secretion, so that the use of the hot flannel 
is better. After the breasts have been massaged 
the binder must be pinned on snugly because 
the uniform pressure tends to prevent disten- 
tion. Until the tension is relieved take very 
little liquid. A good cathartic of Epsom salts 
is very beneficial. 

If the baby is weaned immediately it is neces- 
sary to prevent the breasts from being distended 
with milk by applying belladonna ointment over 
the entire area of both breasts and pinning the 
binder on tightly. Abstain from all liquids, 
taking only occasional sips of water to relieve 
thirst. Use a dosage of Epsom salts for three 
or four days in succession to bring about 
several watery stools daily. Put the hot flannel 
cloths over the breasts if they become too pain- 
ful and gently massage the milk into the flannel 
to give temporary relief. Do not use the breast- 
pump unless the tension is too great to bear. 

The Diet. — The proper diet after confinement 
is of vast importance. It is a mistake to keep 
the mother on liquid or semi-liquid food for 
ten days or two weeks. This is one cause for 
failure of the milk in. the early weeks of nurs- 
ing. For the first day the diet should be milk 
and broth; by the second day, a soft egg, toast 



CARE DURING THE PUERPERIUM 139 

and cereal can be safely added; by the third 
day, providing everything is going well and 
there has been a thoroughly good movement 
of the bowels, let her appetite be the guide 
in allowing a liberal diet of meats, soups, fruits, 
cereals, and vegetables. Use meat no oftener 
than once a day. There is no reason why the 
nursing mother should not choose freely from 
her regular list of foods, avoiding only what 
previously disagreed with her and omitting pork, 
veal, corned beef, cabbage, turnips, cucumbers, 
corn, navy beans, vinegar, strawberries and 
any acid fruit the eating of which is followed 
by an attack of colic in the baby. Tea causes 
constipation. Avoid it except when it is very 
weak. Coffee causes constipation and sleep- 
lessness. Take only one cup in the morning 
and that not strong. Don't try to increase the 
milk by eating quantities of rich food. The 
danger is in an upset digestion which results 
in inability to take properly even a normal 
amount of food. A liberal quantity of milk and 
of well-cooked cereals, especially oatmeal eaten 
with rich cream, also cocoa and plenty of butter, 
help increase the quantity and quality of the 
milk. Nuts, except peanuts, have been found 
valuable. They can be taken by the woman not 
accustomed to them if only a very few are 
eaten to begin with and if they are thoroughly 
chewed, gradually increasing the number as she 



140 MATERNITY AND CHILD CARE 

becomes used to this new food. Nuts have 
been tried out most successfully as a means of 
improving the quantity and quality of the milk. 
The Visits of the Physician. — The mother 
who has the advantage of hospital care is 
usually seen twice a day by [the attending 
physician. If confined at home, fehe should be 
visited once a day for the first eight or ten 
days. At each call the physician will give atten- 
tion to the following details: 

1. The pulse and temperature. 

2. Condition of the uterus, and the after- 
pains. 

3. The quantity and odor of the lochia. 

4. Condition of the external genitals, espe- 
cially if stitches were taken. 

5. The bowels and bladder. 

6. Secretion and condition of the breasts. 

7. The mother's diet. 

8. The baby. 

Later Examination. — Under normal conditions 
the uterus assumes its natural size and position 
by the sixth week. Your physician will then 
call upon you and determine by local examina- 
tion whether the uterus has correctly returned 
to its proper place and proportions. There are 
times when it becomes displaced downward and 
backward, and in such cases your physician 
will give directions and start treatment to cor- 
rect this before it becomes a chronic condition. 



CARE DURING THE PUERPERIUM 141 

If he finds a displacement of any serious con- 
sequence he will usually insert a pessary which, 
will hold the uterus forward. This is usually 
worn for six or eight weeks or even longer, | 
and at the start it often permanently corrects 
such a displacement. 

The physician will give instructions for taking 
the " knee-chest" position twice a day. This 
is done by kneeling on the bed with your 
shoulders resting forward on the pillow and 
your arms folded beneath you or across the 
chest. It is done for fifteen or twenty minutes, 
morning and night. This helps to throw the 
uterus forward in proper place. A correct 
standing and walking poise will also greatly 
help. This is acquired by holding the chest 
high. When the chest is held high the shoulders 
fall into position and the spine and pelvic 
organs are brought into true line. 

Return of Menstruation. — The time when 
menstruation returns is extremely variable. In 
most instances it is sometime between the fourth 
and eighth months, although it may be as early 
as the second or third month and while the 
mother is nursing her baby. If the baby is 
nursed for ten or eleven months, menstruation 
may be delayed a year, or even longer, and in 
prolonged nursing it is sometimes difficult to 
re-establish it. Your physician may have to 
resort to the use of a tonic before the uterus 



142 MATERNITY AND CHILD CARE 

again takes on this function. Prolonged nursing 
is never to be advised. Both the mother's 
health and the child's are unfavorably affected 
by it 



CHAPTER XIII 
THE BABY'S FIBST DATS 

As soon as the baby is born and the cord 
has been tied, the physician or nurse will im- 
mediately dip a sponge of sterile cotton in the 
warm boric acid solution and gently sponge the 
baby's eyelids, from the nose outward. While 
the baby's head is turned slightly to the left, 
clean the left eye and while turned to the right 
side clean the right eye. The physician will 
then gently separate the eyelids and use a one 
per cent solution of silver nitrate, placing one 
or two drops into each eye with the sterile 
eye-dropper. In fifteen or twenty seconds he 
will gently open the eyelids again and with 
sterile cotton soaked in warm boric acid solu- 
tion, thoroughly flush out each eye carefully 
wiping all particles from the eye-lashes. 

This procedure should never be omitted. It 
makes your baby's eyes safe from any infec- 
tion that may have gotten into them during 
birth. Silver nitrate, while stronger than the 
other preparations used for this purpose, is 
safer and always dependable, in fact, there is 
a law in some of our states compelling its use. 

143 



144 MATERNITY AND CHILD CARE 

The eyes may be slightly irritated and reddened 
for two or three days after its use but this 
promptly passes away. No mother should con- 
sider her baby safe from a possibility of infec- 
tion, regardless of her state of health, as any 
baby passing through the birth canal of any 
mother is liable to get something in his eyes 
that may start an infection unless the pre- 
caution is taken of using silver nitrate at once 
after birth. 

The baby should then be wrapped in a warm 
covering preferably flannel and laid out of 
harm's way, where there is good breathing 
space, and left while the mother is being made 
comfortable. The doctor, nurse or attendant 
will observe the baby every few minutes to 
make sure that he is breathing properly and 
that the navel is tied sufficiently snug that 
there is no oozing of blood. 

As long as the baby is comfortable there 
is no need of hurrying with the bath, which 
can be delayed six or eight hours if necessary. 

As soon as the mother's needs have all been 
attended to the baby's bath can be prepared. 
Place within easy reach two basins of water at 
a temperature of 98° to 100° F., one for wash- 
ing and one for rinsing. Keep the baby wrapped 
in a flannel blanket or the flannel apron of the 
one giving the bath. 

On the baby's body there is a fine, downlike 



THE BABY'S FIRST DAYS 145 

substance which we call the vernix caseosa. 
This must be removed before the bath by freely 
annointing the body with sweet oil and then 
gently sponging it off with a soft cloth dipped 
in warm water. Keep the body covered with 
the flannel, bathing only a 'small part at a time. 
The bath should be given in a warm room, 
close to the stove, register or fire. Bathe the 
head and face first. After the first day gently 
separate the lids and sponge off the eyelids and 
lashes with water that has been boiled. "With a 
piece of cotton wrapped around the finger flush 
out the mouth. The ears then are gently cleansed 
taking care to poke nothing into them. 

Next bathe the arms and arm-pits one at a 
time, then the chest and abdomen. Then turn 
the baby over on his stomach and wash his 
back and legs, one leg at a time. Be sure to 
gently wash out all creases, and give special 
care to the genitals, carefully retracting the 
foreskin and cleansing beneath it. No soap 
need be used for this first bath and after the 
baby has been thoroughly and gently sponged 
he is quickly dried with a soft towel, not by 
rubbing but by softly patting the skin. 

At the second and subsequent bathings a 
little pure mild soap may be used and the body 
thoroughly rinsed off with a second basin of 
water. Never let the soapsuds dry on the skin. 
This is the wav the bath should be given daily 



146 MATERNITY AND CHILD CARE 

until the cord has dropped off. The tub bath 
can then be started as described in a following 
chapter on The Baby's Hygiene. 

The cord should be dressed every day by 
putting on a fresh piece of sterile gauze four 
inches square with a hole cut in the center for 
the stump of the cord to come through. Until 
the cord drops off it must be kept scrupulously 
dry. It must not be allowed to get wet during 
the bath or washed in any way, unless other- 
wise especially directed by your doctor. After 
the cord is pulled through the piece of sterile 
gauze, boric acid powder or dermatol should 
be dusted on freely. Over this should then 
be laid three or four thicknesses of sterile 
gauze about the size of the first piece. The 
baby's band will hold the dressing in place. 
Continue to use the dry powder until the 
navel has entirely healed. 

The cord usually comes off on the fifth or 
sixth day, sometimes a little later, and the 
navel is generally entirely healed by the tenth 
to fifteenth day. Be sure the hands are scrupul- 
ously clean when dressing the navel. Unusual 
conditions that develop in connection with the 
navel are taken up in detail in the following 
chapter. 

The baby's band is to keep the cord from 
being pulled upon by the clothes and to furnish 
covering for the abdomen to prevent chilling. 



THE BABY'S FIRST DAYS 147 

This band should never be pinned too tightly be- 
cause if the bowels become distended with gas 
there is danger of severe pressure from a tight 
band that often causes vomiting. The regular 
circular knit band with the tabs in front and 
back for pinning to the diaper, and with shoulder 
straps, can be purchased, or the band can be 
made of flannel, long enough to go a little more 
than once around or about twenty inches, and 
the same width as the knit band which extends 
from the hips well over the ribs, about six 
inches in width. It should be of very soft 
flannel cut on the bias. The flannel band is 
preferable until the cord has come off, although 
either may be worn. The band can be worn 
for the entire first year unless the latter months 
extend into the hot weather when its use can 
be discontinued earlier. The clothes needed 
are described in The Layette, Chapter X. 

In dressing the baby put on the band, then 
the diaper, shirt, stockings and bootees, flannel 
petticoat and dress, in the order named. The 
skirt and dress should be drawn up over the 
feet and not put on over the head. When the 
baby is dressed, wrap it up in the blanket and 
put it in the crib. 

Young babies require a great deal of sleep, 
in fact, they sleep most of the time. It is a 
bad plan to take the baby up every time it crios. 
If it is cross and fussy, see that it is dry and 



148 MATERNITY AND CHILD CARE 

that its hands and feet are warm. If they are 
cold put a hot water bottle in the crib. Change 
the position or rock him, but do not take him 
up. Be sure that your baby is warm and com- 
fortable, fed regularly, kept quiet, never handled 
unnecessarily, and he will make little trouble. 

The skin of the new born babe is of a de- 
cidedly reddish color. If the baby is suffering 
from a congenital heart trouble, or is cold, the 
skin is bluish. The baby is very delicate and 
easily chilled. In a week's time the red color 
begins to fade, the skin often taking on a 
yellowish tint, which varies considerably as 
described in a following chapter. During the 
first week the down, on the skin at birth, begins 
to fall off, and the superficial layer of skin 
sheds in fine scales. By the end of the second 
week all discoloration of the skin has dis- 
appeared, and the natural pinkish tint takes 
its place with the palms, soles and cheeks a 
deeper red. 

The new born baby weighs from five to ten 
pounds, the average weight being seven to seven 
and a half. The length varies from 18 to 22 
inches, the average being 19% to 20y 2 inches. 

The bowels move once or twice during the 
first day. The passage for the first three or 
four days is a greenish-black odorless stool. 
The color changes to canary-yellow when nurs- 
ing is established. This often contains tiny 



THE BABY'S FIRST DAYS 149 

curds of undigested milk. Especially is this 
true if the baby gets more milk than can be 
digested. The movements are from two to 
four a day for the first six weeks and may 
have a slight greenish tinge, which is of no 
significance, and which is noticeable a short time 
after the movement has occurred. 

The urine of the young baby is almost like 
water, odorless and does not stain the diaper. 
Although no urine may pass until the second 
day, it is usually passed before the first 24 
hours has expired. If it goes any longer it 
must be called to your physician's attention. 
Urine is passed from five to ten times a day 
for the first few months. Its frequency is 
variable; it may be every hour and then the 
baby may go several hours and be perfectly 
healthy. 

During sleep the young baby breathes regu- 
larly but during waking hours the breathing 
will be irregular. This is more pronounced 
during the first year. He may hold his breath 
for several seconds without any apparent effort 
or injury. He may take several rapid breaths fol- 
lowed by several long ones. The average breaths 
will be twenty-five to thirty a minute for the 
first year. The young baby's breathing is mostly 
abdominal, from the diaphram rather than the 
chest. You can determine the rapidity by watch- 
ing the abdomen. 



150 MATERNITY AND CHILD CARE 

The pulse of the new baby is extremely irregu- 
lar, even when he is asleep and perfectly normal. 
Any slight excitement, such as crying or nurs- 
ing, will greatly increase the heart beats. An 
increase of twenty to twenty-five or even more, 
per minute, need not cause any alarm the first 
two or three years, and during the first year 
it may vary from 120 to 140 beats per minute. 
The general average is 125 to 130. 

The baby's temperature is usually about 99y 2 
to 100° after birth and settles down after the 
first week or ten days to a normal infant 
temperature of 98%° to 99° F. Very slight 
disturbances will cause a sudden rise, such as 
crying or hard struggling of any kind, taking 
too much food and overloading the stomach, 
or being handled too much. The temperature 
will vary greatly during the day; there may be 
a difference of two degrees in twenty-four hours. 
This should not cause alarm. If the temperature 
sinks as low as 97° or 96° or rises to 100° or 
over, persisting for twenty-four hours, the physi- 
cian should be notified and a search made for 
some cause. 

Every mother should have a clinical thermome- 
ter and learn how to use it. It need not be used 
every day, but whenever the baby seems to be 
ailing his temperature should be taken. The tem- 
perature of the baby should be taken in the arm- 
pit or by the rectum. It is not safe to try to 



THE BABY'S FIRST DAYS 151 

take it by the mouth in a child younger than five 
or six years, because of the danger of biting the 
thermometer. In taking the temperature by the 
rectum, the point is well oiled, and it is easier 
if the baby is laid on his side. It need not be 
inserted further than an inch or so, carefully held 
in the hand and withdrawn in three minutes. It 
is then washed in soap and cold water, disinfected 
with boric acid solution, then shaken down ready 
for use. 

Always remember that a little fever in the baby 
without any other disturbance is not of much 
consequence and should not disturb the mother. 
It may be only a slight indigestion. But if the 
baby is vomiting and has diarrhea or looks pale, 
sick and prostrated, the presence of fever must 
be heeded. 

After the mother has had several hours rest 
following delivery, the baby must be put to the 
breast. The act of nursing is important. It 
greatly helps the contraction of the uterus, it 
stimulates the breasts to secrete milk. The baby 
first obtains the substance known as colostrum, 
which is supposed to have a very helpful effect on 
the digestion. 

By the second or third day the breasts usually 
begin to secrete milk. The child does not need 
any extra nourishment up to this time except 
that obtained in the colostrum, but he should have 
warm water, which has boon boiled and into which 



152 MATERNITY AND CHILD CARE 

has been put a tiny pinch of sugar. This is given 
in a nursing bottle every two hours. Do not begin 
giving modified cow's milk right away; await 
until the third day to see if the milk is established 
before you start artificial feeding. 

The child must not be put to the breast every 
time it cries but at regular intervals, as follows: 

First four weeks 7, 9, 11 A. M. 1, 3, 5, 7, 9, 12 P. M. 4 A. M. 

Second month. .7, 9:30, 12 A. M. 2:30, 5, 7:30, 10 P. M. 3 A. M. 
Third to Fifth months. .... .7, 10 A. M. 1, 4, 7, 10 P. M. 3 A. M. 

Fourth or fifth months to one year. .7, 10 A. M. 1, 4, 7, 10 P. M. 

Note: Gradually lengthen the intervals, when you change 
from the two-hour to the two-and-one-half-hour schedule, tak- 
ing 3 or 4 days to change. 

Hold the baby in the proper position when 
nursing. Be slightly propped up in bed at first. 
Eest on your side with the infant's head in the 
bend of your right arm to nurse from the right 
breast and in the left arm for the left breast. 
Later when sitting up lean slightly forward, 
bringing the breast and nipple into a more com- 
fortable position for the baby to nurse without 
sucking air or getting his nose buried in the flesh, 
thus making it hard for him to breathe. Gently 
compressing the breast at the nipple regulates 
the flow of milk if it comes too freely. Nurse 
from one breast at one nursing, from the other 
at the next and so on. Most babies empty one 
breast at a nursing. Don't give both unless the 
supply is scanty. Emptying the breasts com- 




The Correct Nursing Position 
Courtesy of The Maternity Center Association, New York City. 



THE BABY'S FIRST DAYS 153 

pletely stimulates the secretion of milk and gives 
the baby a well-balanced nursing, as the last milk 
in the breast contains more fat than the first. 

By strictly observing the regular nursing pe- 
riods your breasts secrete milk better. Your 
baby's stomach has only a limited capacity and 
takes just so long each time to digest the milk 
and needs a certain rest afterward. Digestion 
together with the whole process of assimilation 
of the food with the elimination of the waste 
through the bowels is likewise kept in proper 
order. Irregular nursing throws this whole sys- 
tem out of order and results in indigestion, colic, 
vomiting, diarrhea and constipation. Nurse your 
baby by the clock, wake it to nurse and never 
permit your other duties or pleasures to inter- 
fere. Sit in a comfortable chair in a quiet room 
by yourself. Eelax, think about pleasant things 
and give your whole, undivided attention to the 
baby at each nursing. This is for its good health, 
and is one of the secrets of successful nursing. 

The baby should take fifteen to twenty minutes 
to nurse. If it is a rapid nurser or your milk 
flows freely, he may get too much in this time. 
You must weigh him to find out, for if it is over- 
fed it results in serious indigestion. Nurse and 
then weigh it. Nurse another minute, and weigh 
again. By this method you find out just how 
many minutes it takes to get the right amount 
of milk for the infant's weight. Refer to the 



154 MATERNITY AND CHILD CARE 

table that follows for the amount the average 
healthy baby requires at various ages. If your 
supply seems scanty or the milk is poor you 
must also weigh him to find out if he is getting 
too little milk. Use your scales faithfully, weigh- 
ing the baby each week and keep a record of 
these weights. They, with the baby's general 
appearance, are your best guide about his good 
progress. 

The delicate baby with limited powers of diges- 
tion, and who does not nurse as vigorously as the 
strong baby, may have to be kept longer on the 
two-hour schedule. The weak or lazy baby may 
fall asleep while nursing and have to be kept 
awake, or may need longer than fifteen or twenty 
minutes, taking little rests. 

The first month the baby takes one-sixth to 
one-fifth of his body weight in milk every twenty- 
four hours. For example, the baby weighing 
seven and one-half pounds or 120 ounces at birth, 
has gained by the fourth week ten ounces, or a 
total weight of 130 ounces, which is between five 
and six times the amount of food he should take 
every twenty-four hours. After that up to the 
sixth month, the baby takes one-sixth to one- 
seventh of his body weight in food and after that 
about one-eighth. From the table you will see 
the average normal baby's gain in weight. If 
your baby is not getting enough food the first 
sign is failure to gain in weight; then there will 



THE BABIES FIRST DAYS 155 

be restlessness, crying before feeding time and 
at the breast and remaining longer than usnal. 
The baby should not take more milk at one nurs- 
ing and less at another, sometimes refusing to 
finish. He should be taken away when he has had 
his schedule amount and not allowed to overload 
his stomach, thereby bringing on colic and a long 
train of ills from indigestion. These are all ex- 
plained in detail in the volume, The Proper Feed- 
ing of Infants. 

If the mother's milk is poor in quantity and 
quality she should build it up by careful atten- 
tion to her diet and hygiene, drinking a glass of 
milk between meals and at bedtime, eating more 
wholesome foods, resting if she is overworking, 
and by taking more exercise outdoors if she is 
not exercising enough. 

Some mothers are able to nurse their babies 

FEEDING TABLE AND WEIGHT INCREASE FOR THE 
AVERAGE, NORMAL BREAST-FED BABY 

Number Total 

Amount of amount Increase 

at each feedings in in 

feeding, in 24 hours, weight, 

Age ounces 24 hours ounces ounces 

First 5 days 1 10 10 

6th to 14th day ^ 10 17V> VA 

3rd week 2 10 20 7V> 

4th week 3 8 24 10 

5th to 8th week 3*4 8 26 32 

9th to 12th week 3V> 8 28 24 

13th to 16th week 4% 7 29^ 24 

17th to 20th week 5 6 30 20 

6th month to 1 year 6 to 8 6 36 to 48 15 to 17 

each month 



156 MATERNITY AND CHILD CARE 

only two months, some not that long, but the 
majority nurse six or seven months; nursing 
should not be prolonged beyond the ninth or 
tenth month at the latest, and the eighth is the 
correct month for the average mother to start 
weaning. 

ARTIFICIAL FEEDING 

If artificial feeding is necessary, the mother's 
problem is one which requires the most careful 
study from the beginning. This subject is dis- 
cussed most thoroughly and every detail of the 
care and feeding of the baby is painstakingly ex- 
plained in the volume, The Proper Feeding of 
Infants. The following table will give the mother 
some idea of the first formulas to be prepared, 
but before she proceeds at this critical time in 
the young baby's life, when his digestion must be 
gradually made to adapt itself to an entirely 
foreign food, she should carefully study the guid- 
ing rules for artificial feeding that are laid down 
in the first book. 

One word of caution to the mother who cannot 
nurse her baby. The disastrous results that fol- 
low in the wake of artificial feeding are due, nine 
times out of ten, to the fact that too strong a 
formula is used. Cow's milk is so essentially dif- 
ferent from mother's milk that it can only be 
successfully fed to the young baby in small 
weak amounts with an increase so gradual that 



THE BABY'S FIRST DAYS 157 

the digestion is able to accustom itself to the 
strange food. Your baby will not gain on the 
weak formulas, but if he appears to be digesting 
the food, showing even a slight increase in weight 
after the tenth day, you can be well satisfied. 
If you follow this schedule you will be able grad- 
ually to increase the strength of the food by the 
end of the month. But if you start, as so many 
mothers do, with a stronger formula the baby's 
digestion will unfailingly be thrown out of bal- 
ance, and then in an effort to find something that 
will be taken by the enfeebled digestion in the 
change from one food to another your baby's life 
will be endangered. On the other hand this can 
be easily avoided if, in the beginning, you see 
to it that the greatest caution is observed in feed- 
ing these weak mixtures. 

FORMULAS FOR THE FIRST DAY TO THE SECOND MONTH 

First and Second Days divide the feeding accurately 

Sixteen ounces of plain so that the baby gets the right 

boiled water, sweetened with amoimt > no raore and no less - 

one teaspoonfui of milk sugar Ttttrd AlsrD fourth Dvrs 

(not cane or table sugar) for iHIRD AND * 0URTH DAYS 

the twenty-four-hour feeding. Ten ounces of water, six 

Give one ounce every three ounces of skimmed milk, one 

hours from a nursing bottle. teaspoonfi* of milk sugar. 

(Do not use more than one Boiled for three minutes, if 

teaspoonfui of sugar for the over the direct fire, and if in 

entire sixteen ounces.) the double boiler, have the 

Note: If your baby is quite water in the outervessel boil 

frail and unable to take the eight minutes. This sixteen 

full ounce, you may have to ounces is the feeding for 

give less at a feeding and twenty-four hours. (Add 

feed every two hours for the enough boiled water to make 

first month. In this event up for what evaporates in 



158 



MATERNITY AND CHILD CARE 



boiling.) Feed one ounce 
every three hours from the 
nursing bottle. Discard what 
is left over. Make up the 
twenty-four-hour mixture in 
this proportion. Do not try 
to make up the exact amount 
for each feeding separately 
or you will fail to get the 
proportions correct. The baby 
gets a total of seven ounces 
in the twenty-four hours. 

Fifth and Sixth Days 

Eight ounces of skimmed 
milk, and eight ounces of 
water, with two teaspoonfuls 
of milk sugar. Boil, as di- 
rected for previous days. Feed 
one and one-half ounces every 
three hours in seven feedings. 
This is a total of ten and 
one-half ounces in the twenty- 
four hours. Discard what is 
not used. If you are feeding 
the frail baby every two 
hours, you will use the ten 
and one-half ounces in ten 
feedings, giving a trifle over 
an ounce at each feeding. 

Note: Remember you are 
using skimmed milk, milk 
from which all the cream has 
been removed. You do not 
start using whole milk until 
the seventh day. Whole milk 
contains cream or fat to 
which the digestion must be 
accustomed very gradually. 

Seventh, Eighth and Ninth 
Days 

Four ounces of skimmed 
milk and four ounces of 
whole milk, with eight 
ounces of water and two tea- 
spoonfuls of milk sugar. Boil, 
as directed. Feed one and 
one-half ounces every three 



hours in seven feedings, or 
a total of ten and one-half 
ounces in the twenty-four 
hours. Discard what is not 
used. 

Note: This is the first day 
you start the use of whole 
milk. Whole milk is taken 
from the quart bottle after 
it is well shaken to mix up 
the cream thoroughly. Do 
not take from the top of the 
bottle without shaking as 
this gives too much cream 
and would upset the diges- 
tion. The four ounces of 
whole milk contain enough 
cream to begin with. Be very 
careful about this. 

Tenth, Eleventh and 
Twelfth Days 

Three ounces of skimmed 
milk, and five ounces of whole 
milk with eight ounces of 
water and two and one-half 
teaspoonfuls of milk sugar. 
Boil, as directed. Feed two 
ounces every three hours in 
seven feedings or a total of 
fourteen ounces in twenty- 
four hours. Discard what re- 
mains. 

Note: If any signs of in- 
digestion arise, go back to the 
previous formula of more 
skimmed milk and less whole 
milk and sugar. Indigestion 
shows that the stomach is not 
yet able to digest the fat in 
the whole milk. Some babies 
cannot easily digest sugar 
and have to be fed very cau- 
tiously. 

Thirteenth and Fourteenth 
Days 

Three ounces of skimmed 
milk, and seven ounces of 



THE BABY'S FIRST DAYS 159 

whole milk with eight ounces eight ounces of water and 

of water and three teaspoon- four teaspoonfuls of milk 

fuls of milk sugar. Boil, as sugar. Boil, as directed. Feed 

directed. Feed two ounces two and one-half ounces every 

every three hours in seven three hours in seven feedings 

feedings or a total of four- or a total of seventeen and 

teen ounces. Discard what one-half ounces. Discard 

remains. If any signs of in- what remains, 
digestion, return at once to 

the previous formula of less Fourth Week 

whole milk and sugar. 

Note: Remember, if the Eleven ounces of whole 

stronger formula upsets the milk and ten ounces of water 

stomach and you continue it, with four teaspoonfuls of 

it makes matters worse. milk sugar. Boil, as directed. 

Third Week Feed three ounces ever y three 

hours in seven feedings or a 

Ten ounces of whole milk, total of twenty-one ounces. 

Give one ounce of warm boiled water between feedings. 

Warm the feeding; cold milk and water cause 
colic, Hold the bottle so that the baby gets the 
milk, not air. Air sucked in causes colic. If 
the boiled cow's milk constipates, give fifteen 
drops of milk of magnesia in a little warm water, 
once a day. Sterilize bottles and nipples thor- 
oughly. The slightest dirt on bottle or nipple 
can cause colic and indigestion. Get pasteurized 
or certified milk. (Pasteurized milk need not 
be boiled.) Keep on ice or in cold place. 
When mixture is made for the twenty-four hours 
divide in the nursing bottles, stopper carefully 
and keep on ice. Never use cereal water in any 
form until the baby is two and one-half to three 
months old as he cannot digest starch before that. 

Instructions for feeding the sick baby are 
given in the volume, The Proper Feeding of 
Infants. 



CHAPTEE XIV 
ACCIDENTS TO THE NEW BORN 

It is indeed surprising to find with what fre- 
quency emergencies, which we commonly speak 
of as accidents to the newborn, occur. It is for- 
tunate indeed that most of these so-called acci- 
dents properly cared for prove to be trivial in 
their consequences. The danger comes when such 
unusual conditions are allowed to go untreated 
until they have developed into some serious, last- 
ing and intractable complication. 

JAUNDICE 

One of the most common problems that cause 
mothers great anxiety is the condition known as 
icterus, or jaundice. This may develop in the 
first few days of life and is extremely variable, 
amounting at times to a very slight discoloration 
of the skin and again appearing as a deep yellow 
hue. Fortunately, in most instances it is of lit- 
tle consequence and need cause no alarm. Within 
four or five days, or ten at the most, the dis- 
coloration will disappear entirely. One dose of 
four or five drops of castor oil, after the fourth 
or fifth day, if the jaundice still persists, will 

160 



ACCIDENTS TO THE NEW BORN 161 

hasten its disappearance. It is important that a 
jaundiced baby receive warm boiled water from 
the nursing bottle from the very first day. An 
ounce, sweetened with a pinch of sugar, will 
be readily taken every four hours. This water, 
given between nursings, helps materially in 
flushing from the intestines the substance we 
term meconium, and at the same time to 
increase the normal activity of the kidneys. 
The cleansing of the intestines of this substance, 
some of which has been swallowed during labor, 
facilitates the return of the skin to the normal 
pink color. Should more strenuous treatment be 
found necessary it must always be carried out 
under the direct supervision of your physician. 
However, I am of the opinion that many times 
medicines which are too powerful are adminis- 
tered to the newborn babe in an attempt to clear 
up the yellow color of the skin, and the results 
are a serious disturbance of digestion. The sim- 
ple suggestion that I have given you here will 
almost always prove efficacious and can do no 
harm. 

Jaundice may at times be more serious and 
persistent. It will then be found to be the result 
of a more deep-seated cause, and calls for the 
studied attention of your physician. I again 
want to impress upon your minds the importance 
of not worrying over this situation. Moreover, 
anxiety of any kind only disturbs your milk. 



162 MATERNITY AND CHILD CARE 

Your mind must be kept free from all care and 
worry if you hope to be successful in nursing 
your baby. 

CAEE OF THE NAVEL 

When the mother does not have the advantage 
of hospital care the dressing and attention of 
the navel of her newborn babe is often left in 
her hands. Under normal conditions, if the navel 
is kept perfectly dry and clean, the small stump 
or cord falls off on the fifth or sixth day leaving 
a clean healing surface, which, by the twelfth or 
fifteenth day, has closed over entirely. 

In dressing the navel, unless strict aseptic pre- 
cautions are taken, some infection may gain en- 
trance around the stump. This may even spread 
to the surrounding tissues over the abdomen and 
set up a more or less violent inflammation. Dan- 
gerous and even fatal infections can gain en- 
trance to the blood in this manner. It is there- 
fore of the utmost importance that the most 
scrupulous cleanliness be observed in dressing 
the navel until the wound has entirely healed. 

The gauze and cotton dressings which are used 
in the home must be sterilized with as rigid care 
as every article which is used at the time of con- 
finement. In addition to sterilizing the dressings 
the hands that tend the navel must be thoroughly 
scrubbed with tincture of green soap and hot 
water and then carefully rinsed with sterile water 



ACCIDENTS TO THE NEW BORN 163 

to which one-half teaspoonful of lysol to each 
quart has been added. The navel must be kept 
perfectly dry and for this purpose antiseptic 
powder, such as powdered boracic acid or der- 
matol should be dusted freely over the stump. 

After the stump of the umbilical cord has 
dropped off, the wound must still be kept scrupu- 
lously dry and clean. It can be cleansed gently 
with peroxide, or a boric acid solution, one level 
teaspoonful to a pint of water, kept at the boiling 
point for five minutes, and sterile cotton, then 
covered with a thick layer of boric acid powder. 
If this treatment is carefully carried out there 
will be no difficulty in securing a perfect healing. 

Should it happen, however, that the navel be- 
comes infected and ulceration forms with dis- 
charge of pus, do not hesitate a moment in calling 
your physician's attention to it. This infection 
may even extend beyond the naval, burrowing 
into the surrounding tissues. The skin adjacent 
to the navel will then become red and exceedingly 
tender. 

The best treatment for you to follow in this 
case, until you can secure the aid of your physi- 
cian, is to make a boric acid solution, such as I 
have just directed. Fold a piece of sterile gauze 
into six thicknesses, large enough to cover the 
infected area, place it in the solution, wring it 
out with thoroughly clean hands and place it on 
the affected part. This can be used a little 



164 MATERNITY AND CHILD CARE 

warmer than the baby's body temperature. Leave 
this on for fifteen or twenty minutes, then again 
dip it in the solution and apply as before. Over 
this place a soft folded towel which will serve 
to keep the dressing moist and warm. Continue 
this treatment for one hour then allow an hour's 
rest leaving a piece of dry sterile gauze on the 
abdomen. This treatment persisted in with rigid 
care should promptly check the infection. 

The baby's bowels must be kept open; if neces- 
sary an enema should be used or a few drops 
of castor oil given by the mouth. The infection 
makes the muscles of the abdomen so tender that 
if constipation exists it causes a great deal of 
pain. It is also most important that all straining 
be avoided. As soon as all the redness and in- 
flammation have disappeared the use of the wet 
dressings can be discontinued and the open um- 
bilical surface kept dry by the use of boric 
powder. 

HEBNIA 

One of the most distressing accidents which can 
occur during the first few weeks or months of 
the baby's life is the development of hernia or 
rupture. Let me first explain just what hernia 
is. There are two strong muscles which lie side 
by side and extend from the upper part of the 
abdomen to the lower. If these muscles spread 
too far apart as a result of severe vomiting or 



ACCIDENTS TO THE NEW BORN 165 

straining from constipation, or violent crying, 
or if these muscles are weak as is often the case 
in the premature and feeble infant, a loop of 
bowel can protrude forward between them, usu- 
ally at the weakest point which is the umbilicus. 
This protrusion is known as a hernia. When the 
baby cries or strains this bulging hernia becomes 
more prominent. In fact a hernia does not 
always make its appearance on the surface until 
the baby has had a severe crying spell, or strain- 
ing from constipation, or the abdomen is greatly 
distended from gas. This loop of bowel with 
its covering pushes forward and lies just under- 
neath the skin. With very little pressure it can 
be pushed back into position unless the baby is 
crying hard. 

This type of rupture is known as umbilical 
hernia. As soon as it makes an appearance it is 
important that it be pushed back between the 
muscles and the muscles drawn together and held 
in place. The reason for doing this, you can 
readily understand. If the proper treatment is 
started and carefully persisted in a very la rue 
percentage of hernia appearing in young infants 
can be permanently cured without resorting to 
operations. 

The method commonly practiced of pinning a 
band tightly around the abdomen is not adequate. 
If the band is pinned tightly enough to keep the 
hernia reduced it will be so snug as to cause dis- 



166 MATERNITY AND CHILD CARE 

comfort and will result in vomiting because of 
the severe pressure on the intestines. The best 
thing to do is to take a smooth, flat, wooden or 
steel button about the size of a half dollar, cov- 
ered smoothly with clean gauze or cotton cloth, 
and place it directly over the hernia. Fasten this 
in position with adhesive plaster. Take two 
strips of adhesive plaster, four or five inches 
long. Fasten one strip to the baby's skin firmly 
on one side of the button, draw it tightly to the 
button, fasten on the button along the lower side 
and draw firmly over, fastening the other end 
to the baby's skin on the other side. Do the same 
with the other strip of plaster, fastening it about 
an inch higher up on the skin and along the 
upper side of the button. This holds the button 
in place directly over the hernia and keeps up 
a steady pressure. Over this can be pinned the 
abdominal band, snugly, but not so tight that it 
causes discomfort. This treatment will not only 
keep the hernia successfully reduced but result 
in time in a permanent cure. Occasionally there 
will be a hernia which resists this form of treat- 
ment and if it persists after the first year your 
physician must decide whether an operation is 
necessary. 

There is another form of hernia which appears 
in the groin in boy babies and which is known as 
inguinal hernia. This is a much rarer type in 
the young infant, but when it does make its ap- 



ACCIDENTS TO THE NEW BORN 167 

pearance, demands prompt and skilled attention. 
Because of the fact that so much of the bowel 
may push its way out through the muscles, re- 
duction may be impossible, and what is known 
as strangulation of the bowel results. This is so 
serious a complication that it calls for an imme- 
diate operation to save the child's life. 

If a swelling makes its appearance in the groin 
of your baby do not delay in calling your physi- 
cian to attend it. He will provide you with a 
very simple little rubber truss which will keep 
the hernia reduced, and if you will see to it that 
the truss is kept properly adjusted, the hernia 
will in most instances, disappear permanently, 
although this treatment may have to be continued 
for several months. 

HEMORRHAGE 

One of the' strangest and most unaccountable 
accidents to the newborn baby is a mysterious 
and persistent bleeding. It makes its appearance 
without warning ; usually as an unceasing oozing. 
It comes from the lining membrane of the nose, 
mouth, intestines or from around the navel. 

The little body cannot long endure this steady 
loss of blood. Your physician must put forth 
every effort to check it without delay. Just what 
is responsible for this amazing phenomenon our 
greatest authorities have not yet agreed upon. 
Many are convinced that this hemorrhage condi- 



168 MATERNITY AND CHILD CARE 

tion is the result of some undiscovered infection 
which has found its way into the baby's blood. 

To support this belief let me tell you of a baby 
whose mother developed, when the child was but 
two weeks old, the acute inflammation of the 
throat known as quinsy. In quinsy, as you know, 
pus forms around the tonsil and makes its escape 
either by spontaneously rupturing into the mouth 
or by being liberated by the surgeon's knife. This 
mother continued to nurse her baby and some of 
the infection or pus must have passed into her 
blood and found its way into her milk. In a' very 
few days after this, blood began oozing from the 
baby's nose, mouth, and intestines. 

The one thing that might have saved this 
baby's life and which is the most successful treat- 
men that modern science knows, would have been 
the direct transfusion of a certain amount of the 
mother's blood into the baby's veins. This could 
not be done for the very obvious reason that the 
mother was carrying in her blood the infection 
which was undoubtedly responsible for the child's 
hemorrhage. A transfusion of the father's blood 
in this instance would have then been the proper 
treatment, providing of course his blood was 
in a healthy condition. Unfortunately this treat- 
ment was not carried out until too late. The baby 
had become weakened from the long, continued 
loss of blood. 

The direct transfusion of blood offers, by far, 



ACCIDENTS TO THE NEW BORN 169 

the greatest chance of saving these babies' lives, 
and when the mother is well and in an apparently 
normal condition she should always be the donor. 
If this accident should happen to your baby go 
at once to a well equipped hospital where a trans- 
fusion can be speedily and scientifically made. 

Blood serum, which your physician can procure 
ready for immediate use on short notice has been 
injected subcutaneously in the first stages of hem- 
orrhage, and has at times been successful in ar- 
resting it entirely. The best available treatment 
to use is always a matter for your physician's 
judgment. 



Right here I want to repeat again one of the 
things I specially mentioned in the chapter, The 
Baby's First Days, and to drive home with last- 
ing emphasis the paramount consequence of the 
instructions which follow. 

Failure to give proper care to the baby's eyes 
at the time of birth is responsible for thousands 
of cases of permanent blindness. 

The eyes can so easily become infected while 
the baby is passing through the birth canal, but 
if the simplest precautions are taken immediately 
after birth there will be no danger of the develop- 
ment of any serious inflammation of the eye. 

Many mothers have been inclined to feel af- 
fronted at the suggestion of the possibility of 



170 MATERNITY AND CHILD CARE 

infection in their babies ' eyes, erroneously believ- 
ing that only one kind of infection could be re- 
sponsible for any serious trouble. There are 
many different kinds of infection which can pro- 
duce dangerous inflammation in a baby's eyes, 
and they can and do exist in the birth canal of 
any mother. 

Fortunately many states have passed laws 
which make it absolutely compulsory for physi- 
cians and mid-wives to carry out this proper 
treatment and failing to do so become the object 
of criminal negligence. 

This is what your physician or nurse must do 
directly after the birth of the baby: With per- 
fectly clean hands dip sterile cotton in a warm 
saturated solution of boric acid and gently sep- 
arate the baby's lids, squeezing the boric acid 
solution from the cotton into the eyes. Turn the 
head slightly so that the solution runs from the 
nasal side of the eye outward. Follow this by 
dropping into each eye a one per cent solution 
of silver nitrate. Put one or two drops in each 
eye. In fifteen to twenty seconds gently wash out 
the silver nitrate with the boric acid solution or a 
normal salt solution using the sterile eye dropper 
for this purpose. Only when this treatment has 
been faithfully carried out have your baby's eyes 
been made safe. 

Of course accidents will occur after the baby's 
birth and some infection may be introduced into 



ACCIDENTS TO THE NEW BORN 171 

the eyes. At the first sign of any trouble, should 
the eyes become reddened and inflamed, get in 
touch with your physician at once. Should he 
live at a great distance let him provide you in 
advance with a ten or fifteen per cent solution 
of argyrol, which you yourself can safely use in 
accordance with his instructions, putting two or 
three drops in each eye three times a day should 
any inflammation make its appearance. 



CHAPTER XV 
THE BABY'S HYGIENE 

The great institutions in our large cities are 
crowded with waifs who at birth promise little, 
but who, under proper management, develop into 
healthy children, vigorous in mind and body. The 
child's future health, happiness and usefulness 
are dependent upon the foundation you lay for 
him during the first years. Competition grows 
more intense, the physical fitness of men and 
women for any position is being more carefully 
scrutinized each year, and every child has a right 
to demand from its parents such care and atten- 
tion that when he is ready to enter the "big busi- 
ness" conflict of life, he may do so, not as a 
physical weakling who soon falls behind in the 
great onward sweep of progress, but as one with 
the unlimited resources of a sound body and mind 
secured for his mature years by the foundation 
laid in the nutrition and hygiene of his babyhood. 

Fresh Air. — Food and hygiene are as your 
right and left hands in caring for your baby. 
These are the great growth provisions that every 
mother is given to measure out to her child. In 
the baby's hygiene her first attention must be to 
* 172 



THE BABY'S HYGIENE 173 

fresh air. Vith the best of food there will be 
no results in health and development without the 
aid of the oxygen of fresh air. With the best 
food, baby's cheeks will not grow rosy, his appe- 
tite keen or his digestion strong, if he must live 
on the devitalized air from which others have 
taken the life-giving oxygen. He must have his 
own air as he has his own food. Too often does 
the physician enter the unventilated room to find 
a little helpless patient suffering from nothing 
in the world but the breathing of second-hand air, 
out of which the adults and older children have 
a chance to escape, but in which the baby is im- 
prisoned hour after hour. 

Bathing the Bahy.— The temperature of the 
room where the baby is bathed should be 80° to 
85°. There should be no draughts. The water 
should be 100°. The bath should be given daily, 
preferably in the morning between nine and ten 
and before feeding. The bath should be given 
quickly and the body carefully dried by patting 
with a soft towel. The skin should not be rubbed 
and only the purest soap used and that sparingly. 
A very pure talcum powder should be dusted in 
all creases to aid in complete drying. The head 
should be washed first and no water or soap got- 
ten into the eyes and ears. By the sixth month, 
the temperature of the bath water can be lowered 
to 95°; by the end of the year to 90°. In some 
infants, there is not the proper reaction alter 



174 MATERNITY AND CHILD CARE 

the bath, the babies remaining pale and slightly 
blue about the lips and under the eyes. With 
these babies, the bath should be given but three 
times a week and the child left in the water only 
a few seconds. Everything should be done to 
make the baby enjoy his bath. In hot weather 
the water can be cooler. The baby should not be 
frightened by being lowered into the tub too 
quickly or in any way distressed so that the habit 
of crying through the bathing time is started. 
The bath should not overlap the feeding time 
so that before the mother is through dressing, 
the baby is crying with impatience and hunger. 
Have everything ready that is needed and within 
easy reach; acquire a sure and gentle hand, and 
remember that "haste makes waste.' ' Teach your 
baby to love his bath and your maturing child 
in after years will continue to love the cleanli- 
ness of the daily bath and appreciate its benefits. 

Do not bathe the baby if it has eczema or a 
very reddened skin. This should be gently 
cleansed with olive or sweet oil. If there is a 
cough or cold in the head discontinue the tub 
bath until it is over. 

Nails. — Cut the nails carefully with round scis- 
sors before the bath, and clean away any matter 
that clings to them with a wet toothpick. 

Hair. — The hair should be brushed with a soft 
baby brush. The scalp should be washed thor- 
oughly two or three times a week with a good 



THE BABY'S HYGIENE 175 

lather of mild baby soap, and the hair always 
carefully rinsed and dried. 

The Baby's Clothing. — The clothing should be 
warm, light in weight and soft to the skin. It 
should not confine the free movements of the 
limbs, abdomen, and chest and should have no 
heavy buttons or humpy places to press into the 
flesh. Everything should be supported from the 
shoulders except the band, the diaper being 
pinned to one of the supported garments. Dia- 
pers should be of cotton, soft and pliable. Eub- 
ber diapers make mothers careless. Because the 
baby cannot wet through, he is often left with the 
acid urine in contact with his flesh until it be- 
comes raw and terribly painful. The feet and 
legs and abdomen especially should be kept warm. 
The night covering should be warm but not heavy 
and overloading. This often causes restlessness. 
The outdoor clothing should be all wool in win- 
ter and the baby's head protected from draughts 
and high winds to avert colds and danger of 
inflammation of the middle ear which is more 
common in infancy than we generally think. 
Much caution should be exercised in making 
changes in clothing that is seasonable. 

If the baby's buttocks become irritated, wash 
the diapers in a good pure hand soap rather than 
a laundry soap or strong washing powder, use 
no bluing, rinse thoroughly, and dry in the sun 
or open air. Never iron or starch diapers. 



176 MATERNITY AND CHILD CARE 

The shoes must be roomy giving plenty of play 
for the ball and toes and made of soft pliable 
material. Some of the bones of the foot in the 
baby are undeveloped, being merely soft cartilage 
easily deformed by shoes which pinch. 

The baby for the first year should wear at 
night, the band, a shirt, diaper, and a flannel or 
flannelette nightdress made long enough to com- 
pletely cover the feet, with draw strings in the 
hem so that if the baby gets uncovered his feet 
are always protected. 

Baby's Laundry.— AW. the baby's clothes should 
be laundered separately, and only a pure, supe- 
rior soap used. They should not be dried in the 
basement but outdoors in the wind and sunlight, 
our greatest natural sterilizers. The clothes that 
go next the flesh should not be ironed but put 
on fresh from their sun-bath, clean-smelling and 
thoroughly dry. This is a real health measure. 

Care of the Eyes. — Immediately after birth 
every infant should have instilled into each eye 
one or two drops of a one per cent solution of 
silver nitrate. In a few seconds the eyes should 
then be washed out with the normal salt solution. 
This is imperative ! It will save the eyes of many 
children. The eyes of all babies during birth 
can become infected and this precaution is rapid- 
ly becoming a law in nearly every State. Mothers 
should see that this measure is not overlooked, 
for the danger of infecting the baby's eyes at 



THE BABY'S HYGIENE 177 

birth is always present in every mother from 
many different causes. During infancy, the 
baby's eyes should be sheltered from strong light. 
He should sleep in a darkened room and never 
be allowed to lie in his carriage or crib with the 
sun shining in his eyes. 

Baby's Nose and Ears. — As much as possible 
the nose and ears should be left alone. Clean 
only the lower edges of the nostrils with your _ 
soft wash cloth. Prevent them from becoming 
dry and crusty by the use of sterile vaseline. 
Clean the external ear also with your wash cloth. 
Never poke anything into the ear canal. If there 
is anything the matter with the baby's ear, your 
physician should attend to it. A baby suffering 
from inflammation of the ear will act at times 
like one having colic and will always have 
fever. He will draw up his arms and legs, 
roll his head from side to side and cry out 
with sharp pain. Hundreds of such babies are 
dosed with peppermint and paragoric when there 
is no trouble with the stomach and bowels at all. 
Your physician always carries with him a little 
ear speculum and upon examining the baby's ear, 
if he finds it inflamed, he can instil one or two 
drops of a five per cent solution of phenol in gly- 
cerine, having the baby lie on the opposite side 
so that the solution remains in the ear and comes v 
in contact with the ear drum. If the ear drum is 
inflamed it must be carefully watched from day 



178 MATERNITY AND CHILD CARE 

to day, may be several times during the day, and 
if it is bulging your physician will not hesi- 
tate to make an opening in the ear drum which 
will allow the pus to escape. This frequently 
saves the hearing from permanent impairment 
and prevents that serious complication which 
may occur in babies, known as "acute mas- 
toiditis." Of course every mother realizes that 
this ear trouble is liable to result from careless- 
ness in protecting the baby's head from draughts. 

Care of the Mouth and Teeth. — At the time of 
the daily bath, the mouth should be cleansed with 
a sterile cotton swab wrapped about the mother's 
finger dipped in boiled water which has been 
cooled. This clean water squeezed out of the cot- 
ton flushes out the mouth. The mother should 
always notice the mouth carefully and at the first 
signs of any soreness, it should also be washed 
after each feeding, using a solution of bicar- 
bonate of soda or boric acid and a swab of sterile 
cotton twisted about the finger. This should be 
done very gently. The baby's mouth can be 
greatly irritated by harsh or over-zealous cleans- 
ing. 

If any stains appear on the teeth a little pre- 
cipitated carbonate of lime dusted on the tooth- 
brush will remove them, or, a toothpick dipped 
in powdered pumice stone can be used and the 
teeth and gums thoroughly washed so that none 
of the pumice remains about the gums. Be very 






THE BABY'S HYGIENE 179 

careful not to injure the gums with the end of 
the toothpick. Material must not be allowed to 
accumulate because this causes the teeth to be- 
come infected and the gums to recede, thereby 
loosening the teeth so that they come out long 
before their time. 

As soon as the first teeth make their appear- 
ance, they should be kept clean. A piece of 
sterile gauze and later the first size baby tooth 
brush should be used. Dirty teeth decay. De- 
cayed teeth menace the health and can cause se- 
vere infections. 

The Baby's Shin. — The skin is exceedingly del- 
icate and care should be constantly exercised to 
prevent excoriations, eruptions and eczema. 
Cleanliness is the first requisite and it must be 
accomplished without rubbing and with the pur- 
est soaps only. Diapers must be removed at once 
when they become soiled or wet. A mild, borated 
talcum powder should be used daily in all the 
folds of the skin, behind the ears, the neck, under 
the arms, groins, genitals and thighs, and 
wherever there are folds of fat. If the water 
irritates the skin, a tablespoonful of salt to the 
gallon of water will soften it. Pure cow's cream, 
cold cream or sterile vaseline for chafed or 
chapped skin, and ointment of zinc oxide for the 
urine burns, will relieve these conditions. 

Care of the Genital Organs. — Cleanliness is 
all that is required in girl babies. In boys, early 



180 MATERNITY AND CHILD CARE 

care should be given to the foreskin if long or 
adherent. At the d^ily bath the foreskin must 
be completely retracted and cleansed. When it 
is so adherent that it cannot be drawn back and 
it is impossible to clean beneath it, circumcision 
is advisable. Accumulated secretion results in 
nervousness, bed-wetting and bad habits. 

Care of the Bowels and Urination. — At six 
months the baby can be trained to have its bowel 
movements regularly, if supported on its chamber 
chair. This should be done at a regular hour 
after feeding, and a time should be established 
for this systematic, daily evacuation of the 
bowels that will not in later life interfere with 
the child's other duties. The importance of 
establishing good bowel habits cannot be over- 
estimated. The child's health through life is di- 
rectly dependent upon it. By the end of the first 
year, many babies can be trained to indicate their 
desire to empty the bladder. With a little train- 
ing, the child of two and two and a half years 
can be quite independent of the napkin. By the 
age of three a normal child can go from 10 P. M. 
until morning without emptying the bladder. 

Care of the Nervous System. — Noise, commo- 
tions, disturbance, and jouncing, tickling and 
amusing the baby all tend to make a nervous 
child. Showing off the baby with its attendant ex- 
citement and laughter is an injury that no wise 
parent will permit. The little brain grows more 



THE BABY'S HYGIENE 181 

in size in the first two years than in all the 
remaining years of life and for a healthy, normal 
development it requires a quiet, peaceful environ- 
ment free from excitement of any kind. 

Sleep. — A healthy baby, during the first few 
weeks, sleeps from twenty to twenty-two hours 
out of the twenty-four. Hunger, discomfort or 
pain are the only disturbants. For the next six 
months, a well baby will sleep sixteen or eighteen 
hours a day and will waken for only half -hour to 
two-hour intervals. At the age of one year, most 
babies will sleep twelve hours at night and three 
or four hours during the day, in two naps. 

Train your baby from birth in good sleeping 
habits. Put it in its crib and let it go to sleep 
without rocking or attention. Never let it go 
to sleep with anything in its mouth and do not 
let it sleep at the breast. If for any reason your 
baby has acquired the bad habit of not going to 
sleep, without rocking or undue attention, start 
at once to break the habit. A little crying will 
not hurt the normal baby, and after a few nights 
you will find the fussing discontinued, if you will 
let it alone. 

Train your baby to take his long sleep of five 
or six hours at night, and the short sleep of two 
to three hours during the day. Do not, however, 
let it sleep through or past the feeding time. 
Waken it promptly to establish strict regularity 
of feeding. If you take the child up whenever 



182 MATERNITY AND CHILD CARE 

it fusses or cries you will find the habit fastens 
itself almost immediately and will not only give 
you a great deal of trouble and loss of sleep but 
will prove a drawback to the baby's development. 

Irregularity of feeding with its consequent dis- 
turbances of digestion is by far the occasion of 
more sleeplessness and restlessness than any 
other cause. 

Exercise. — By normal crying, the baby gets its 
breathing exercises. By kicking its legs, tossing 
its arms and moving its head, its muscles are 
exercised. As the baby grows older it tumbles 
about the bed and should have the opportunity 
in a sufficiently warm room to develop its muscles 
without restraint. Carefully guarded exercises 
will intelligently direct the expansion of a too 
narrow chest, weak back, or legs. The baby 
should not be allowed to sit up on its spine unsup- 
ported until the ninth or tenth month, or to stand 
on its legs until after the first year if he is a 
normal, healthy baby. If your baby has any 
weakness, do not encourage this until you feel 
sure the little spine and legs are sufficiently 
strong to permit it, and even then it is wise to 
u go a little slow." 

Outdoors. — By the end of the first week, if 
the weather is warm, the baby can go out for its 
airing and be kept outdoors two hours each day 
as long as it is dry and sunny. In the fall and 
spring the temperature should be above 60° F., 



THE BABY'S HYGIENE 186 

and the baby at least a month old bei'orfe 
he goes out; fifteen or twenty minutes at 
first, then gradually longer until it remains 
out two or three hours or more. Accustom 
the baby to the outdoor air by dressing him 
for its outing the first day and opening the doors 
and windows without actually taking it outdoors. 
If it is winter, this can constitute the baby's air- 
ing for several months. It needs plenty of fresh 
air winter and summer, but fresh air does not 
necessarily have to be cold air. After the fourth 
or fifth month, the child can go outdoors if the 
temperature is not below 20° or 25° F. High 
winds and dampness should be avoided. Sleep- 
ing outdoors with the proper precautions has 
proved a most beneficial practice for the babies 
who have come under the observance of many 
authorities. Delicate children should not be ex- 
posed to changes in temperature, even with the 
proper change in clothing that the robust baby is 
accustomed to, but must be very carefully 
guarded during the cold or damp weather. After 
the fourth or fifth month, weather permitting and 
with the proper clothing, the baby can remain 
outdoors the greater part of the day. It can be 
left to sleep quietly in his carriage or crib in a 
sunny sheltered place. It is not good for it to 
be rolled about the uneven streets in the dust and 
noise. 

The Nursery. — Sunshine and good ventilation 
are indispensable for the nursery. The tempera- 



184 MATERNITY AND CHILD CARE 

ture should be 70° at first during the day and not 
below 65° at night. After two months 60° or 
even 50° at night. There should be no draughts. 
Ventilators should be in the windows. Clothes 
should not be hung to dry in the nursery, and 
food should not be cooked or left there.. The 
heating apparatus should be protected, whether 
stove or steam pipes, so that there is never dan- 
ger of the baby's coming in contact with the hot 
surface. This has been the cause of too many 
frightful burns. Gas should not be kept burning 
at night; it uses up the oxygen. There should 
be no heavy hanging or dust-collecting germ- 
gathering furniture or carpets. The baby should 
always have his own separate bed. He should 
never under any circumstances sleep with the 
adults or other children. The crib should be sta- 
tionary, never with rockers. A firm, hair mat- 
tress and a down pillow should be used with cot- 
ton sheets and all-wool blankets. The nursery 
should be as large a room as possible so that a 
sufficient supply of good air is always available 
without draughts. 

The bedding should be aired regularly each 
day, always in the sun, and the baby should never 
be put between damp or cold sheets or blankets. 

Flies. — All that has been written on this sub- 
ject is still not enough to impress those who at- 
tend the baby with the weight of the fact that 
the fly is the greatest common carrier of filth 



THE BABY'S HYGIENE 185 

and disease, that he goes germ-laden from the 
foulest hole and most putrid mass of decaying 
matter to your own clean baby's little drooling 
lip, unless you see to it that the carriage and 
crib and room are protected by adequate netting. 

Creeping. — Never permit creeping on bare or 
cold or dusty floors. Let the baby have a big 
bed to exercise on, or a large clean blanket or 
rug that can be aired and kept clean. 

The Baby's Bottle.— The baby's bottle and 
everything used in the preparation of its food 
and fresh water must be kept scruplously clean 
by sterilizing in boiling water. The bottle should 
be of the approved, easily cleaned type, and there 
should be a sufficient supply of bottles and nip- 
ples so that the carefully sterilized bottle is al- 
ways in readiness and so that there is always a 
fresh nipple, if the bottle accidentally falls on 
the floor. 

Kissing. — Kissing a baby on the mouth is a 
most pernicious practice. The mother should not 
permit it. 

Togs. — Toys should be selected that can be 
washed and none should be allowed that have 
colors that rub off or that have corners which can 
hurt or scratch the tender skin. 



CHAPTEE XVI 

THE BABY'S GROWTH 

By observing and carefully studying the usual, 
the average, and the normal, we are able to rec- 
ognize the abnormal. You learn whether your 
child is too fat or too thin, too nervous or too 
bright, by comparing him with the average child. 
Information and statistics are now so available 
that every parent is able to study the individual 
child by contrasting him with the other average 
child or the other abnormal child. Because 
printed reports in the old days were not so ac- 
cessible to every family, parents used to "crow" 
a bit over the abnormally bright child. They 
would term the child below normal as backward 
or awkward, calling it the "unlucky one" or "the 
ugly duckling." The parents who might have 
been tempted to say a generation ago, that a cer- 
tain child was born under an "ill-fated star," to- 
day have the child examined to see if the trouble 
is adenoids, which if removed may change the 
entire appearance of the so-called "star." The 
"little black sheep" we now know may simply 
be the nervous child, and the "ugly duckling," 
dark and scrawny, plainly needs its tonsils out 

186 



THE BABY'S GROWTH 187 

and its teeth taken care of. The one who is 
"slower than molasses in winter " and who will 
"never get on" just wants a little mineral oil 
at bedtime and a different diet, while the abnor- 
mally bright child that we used to force and 
excite by too much showing off, we now gently 
restrain, keeping the precious nervous energy 
from being unwisely scattered. So we use these 
reports of the average, normal child, gathered 
by our greatest authorities by painstaking tests 
and observances, to find out in what way our 
own child differs, and on learning the difference 
to set about righting anything that may be wrong. 

TABLE SHOWING AVERAGE WEIGHT AND LENGTH FOR 
FIRST FOUR YEARS 

BOYS WEIGHT GIRLS 

Birth 20.1 in. 7 lbs. 8 oz. 19.3 in. 

1 month 20.7 in. 8% lbs. 20.2 in. 

2 months 21.8 in. 10% lbs. 21.6 in. 

3 months 22.7 in. 12% lbs. 22.3 in. 

4 months 23.7 in. 13% lbs. 23.1 in. 

5 months 24.1 in. 15 lbs. 23.7 in. 

6 months 24.6 in. 16% lbs. 24.2 in. 

8 months 25.8 in. 18% lbs. 25.3 in. 

10 months 26.4 in. 19% lbs. 26.5 in. 

1 year 27.7 in. 21% lbs. 27.2 in. 

2 years 32.0 in. 28 lbs. 31.7 in. 

3 years 35.5 in. 32 lbs. 35.0 in. 

4 years 37.5 in. 35 lbs. 37.0 in. 

By the end of the fifth month, the birth weight 
is doubled ; by the end of the year, trebled. The 
average weight of boy babies is a trifle more than 
that of girl babies at the end of the first year, 
amounting to a difference of one-half to one and 



188 MATERNITY AND CHILD CARE 

one-half pounds. For the first few months breast- 
fed babies usually weigh a little more than those 
artificially fed, but are about the same by the 
end of the first year. 

Like plants, children seem to grow more during 
the warm weather. School statistics show that 
July and August are the greatest growing 
months, September to February showing the 
least growth. Babies born in the summer seem 
later to be larger than those born in the cold 
months, according to some authorities. 

TABLE SHOWING DEVELOPMENT OF THE HEAD AND 

CHEST 

Circumference of 

Circumference of Chest at 

Head Nipple-line 

Birth 13.0 to 13.8 12.6 to 13.0 

6 month 16.5 to 17.7 16.1 to 16.5 

1 year 17.7 to 18.1 17.3 to 18.1 

2 years 18.5 to 18.9 18.5 to 19.1 

3 years 19.1 to 19.7 19.7 to 20.1 

The chest at the time of birth should not be 
more than four-fifths of an inch or one inch under 
the circumference of the head. At one year, it 
should be about the same circumference and at 
three years, the chest development is not up to 
the average if it has not exceeded the circum- 
ference of the head. 

General Proportions.. — The young infant's legs 
appear short because the lower portion of his 
body measuring from the top of the hip bones, 
is about the same length as the upper portion. 



THE BABY'S GROWTH 189 

In the adult, this lower portion is nearly sixty- 
three percent of the entire body. Approaching 
puberty the growth of the lower portion of the 
body is more rapid to a marked degree than the 
upper portion. 

THE HEAD 

The head in the newborn infant is very long, 
about one-fourth of the total body length, while 
in the adult, the head is about eleven per cent 
of the total length. The shape is decidedly dif- 
ferent. The face is very much smaller in pro- 
portion than the cranium. The swellings or ir- 
regularities in the head occasioned by birth gen- 
erally disappear by the tenth to the fifteenth day. 
As the bones of the skull are not united at the 
time of birth, the baby's skull may become slight- 
ly misshapen from lying too long on the back 
of the head. 

On the top of the head at the time of birth 
there are located two spots which are not cov- 
ered with bone. They are termed the fontanelles. 
The larger one is in front and does not become 
completely closed and covered by bone until the 
seventeenth or eighteenth month. This period 
may be a little longer, but should never exceed 
two years. Should the fontanelles remain un- 
closed for a longer period, it is a very suggestive 
sign that the baby is suffering from some degree 
of rickets. The posterior fontanelle is much 
smaller and is usually completely closed by the 



190 MATERNITY AND CHILD CARE 

tenth week. The explanation for these open 
areas is found in the fact that the brain grows 
much more rapidly than the bones of the skull, 
and these openings admit of great expansion. 
The skin over the f ontanelles should not bulge or 
be much depressed. 

The Scalp. — The scalp is usually sparcely cov- 
ered with hair at the time of birth, occasionally 
a baby will have rather long, dark hair, which 
it retains for several months. In most babies, 
however, the hair falls off within a short time 
leaving the head quite bald. The new hair may 
be even as late as six months in coming. It is 
lighter in color and of firmer texture as a rule 
than the first hair. Oily scales may appear on 
the scalp, and unless these are removed by the 
use of a soft brush and oil gently massaged into 
the scalp, they are apt to accumulate in great 
masses covering the entire scalp. This is com- 
monly known as milk crust. Beneath these crusts, 
the scalp may become very much inflamed and 
painful. Milk crust is removed by carefully soft- 
ening the scales by the use of sweet oil, and as 
they are softened they can be brushed off. Milk 
crust is also known as cradle-cap. 

The Eyes and Ears. — It is several weeks be- 
fore the baby's eyes seem to gain any expression. 
They appear to be of deep blue or blue-grey hue, 
and it is some time before the mother can really 
tell what color her baby's eyes are going to be. 



THE BABY'S GROWTH 191 

He lies with them tightly closed or half shut 
most of the time, but blinks at the presence of 
light. The eye-balls do not always move to- 
gether, making no attempt to focus on an object 
for a number of weeks. The baby under three 
months rarely sheds tears. The second month, the 
baby begins to notice objects and turn to the light. 
From the third month on, he begins to follow 
with his eyes bright or moving objects and fa- 
miliar faces. He does not notice the difference 
between colors much before the end of the year. 

In a few days after birth, air having entered 
the ear cavity normally, the baby becomes sensi- 
tive to sound and is disturbed by loud noises. 
Some babies have a very acute sense of hearing 
and are easily awakened especially by shrill 
sounds. Babies are usually eight or nine weeks 
old before they recognize the direction of sound 
and turn toward it. Many babies at the age of 
one year seem to recognize musical tones, and 
before that time have learned to distinguish 
different voices. 

Smell and Taste. — The baby has very little 
sense of smell during the early months although 
he generally recognizes the odor of milk. His 
taste, however, is more sharply developed and 
it knows the difference between sweet and bitter. 
The taste for sweets is the most strongly devel- 
oped. Babies will readily take any kind of medi- 
cine which has been sweetened. They will as 



192 MATERNITY AND CHILD CARE 

readily reject anything of a bitter taste, showing 
that this sense is also present in a marked de- 
gree. Inasmuch as the more complex savours 
are detected by the sense of smell, and as the 
baby has little sense of smell which develops very 
slowly, a keen sense of taste does not appear for 
several months. 

Mind and Speech. — Laughing and crying are 
the first mental powers the baby exhibits. Cry- 
ing from hunger or discomfort in the young in- 
fant is more or less mechanical and the baby 
is probably not conscious of any suffering. Con- 
scious smiling or laughing are not evidenced 
until the second or third month. The baby does 
not laugh with knowing pleasure much before 
the sixth month. In the third month, he recog- 
nizes his mother and seems to understand when 
preparations for nursing are being made. In 
the third or fourth month, the baby reaches for 
objects and tries to get them in his mouth. He 
seems to manifest an interest in light and mo- 
tion, turning toward bright and moving objects. 
At six months, the baby knows other familiar 
persons besides its mother, and recognizes places 
that it is accustomed to be in. "When baby is 
nine months old, he begins to understand many 
simple things and will respond to suggestions by 
playing "boo" or "bo-peep." By the first year, 
he has developed the idea of choice and shows 
likes and dislikes. During the second year, the 



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THE BABY'S GROWTH 103 

baby exhibits moods of anger, temper, impa- 
tience, fear, anticipation, excitement and joy. He 
also senses quantity and number. 

During the first two months the sounds of the 
infant, like its motions, are almost automatic. 
During the third or fourth month the baby utters 
many sounds which may resemble words but 
which have no conscious likeness, and it is not 
before the eighth month that the average baby 
utters the first simple conscious syllable. At a 
year and a half, there is a small vocabulary to 
express the simplest wants and daily customs, 
and after the second birthday, the baby will 
begin to put words together. The mother must 
remember that speech is often delayed in a per- 
fectly normal baby three or four months beyond 
the normal time. 

SKIN AND TOUCH 

The infant's early dark color which proves so 
disappointing to the mother gives place to his 
normal baby-pink after the second week and the 
downy substance on the skin has disappeared 
with the superficial scales of the skin by the end 
of the third week. There is practically no per- 
spiration for the first month, then the sweat 
glands become active and there is a noticeable 
amount of perspiration over the entire surface 
of the body. Profuse sweating about the head 
often accompanies indigestion and is a very com- 



194 MATERNITY AND CHILD CARE 

mon early sign of some disturbance of nutrition. 
The sense of touch is present from the earliest 
days and is one reason why infants must be very 
gently handled and never jabbed or prodded to 
attract their attention. Coarse, harsh clothing, 
towels and bedding irritate the sensitive skin. 
This sensitiveness easily increases during the 
first year. Especially sensitive are the ear and 
forehead. The skin is sensitive to heat and cold 
as shown by the baby's discomfort when chilled 
and the soothing effect of a warm bath. The 
sense of heat and cold are very marked in the 
mouth. Babies refuse cold water or milk. 

THE SPINE 

The newborn baby's spine has great flexibility 
and none of the later natural curves are appar- 
ent except that at the base. The neck is in real- 
ity relatively longer than in the adult but ap- 
pears short because of the folds of fat surround- 
ing it and the height of the breast-bone. It is 
not until the baby begins to hold up his head, to 
sit up and later to walk that the curves begin to 
form in the neck and back. The lower part 
of the spine grows faster than the upper until 
after puberty. Because of the great pliability 
of the spine, the baby should not be allowed to 
sit upright with his back unsupported before the 
ninth or tenth month. 



THE BABY'S GROWTH 195 

THE CHEST, ABDOMEN AND PELVIS 

As we have seen from our comparative meas- 
urements in the Tables, the baby's chest is small 
in early infancy in proportion to its later devel- 
opment and to its head. And it is small com- 
pared with the abdomen. The narrow chest and 
shoulders, big head and abdomen give the body 
an odd appearance, like a small barrel. The nip- 
ples are tiny and situated as in adult life. The 
ribs are more horizontal in infancy than in child- 
hood and the lower ribs more prominent. The 
young baby's chest is practically round and as 
he grows older, the development is more pro- 
nounced from side to side. 

The baby's abdomen is prominent because of 
the comparative smallness of the chest and pelvis, 
and because the liver is two and a half times 
larger than in later life, proportionate to the 
size of the child. Until the baby is two years 
old, the abdomen equals the chest in circumfer- 
ence. The hips in boy babies equal the width of 
the shoulders but are slightly wider in girl 
babies. 

The Umbilicus. — The umbilical cord which is 
in the center of the abdomen drops off about the 
fifth or sixth day, leaving a smooth red healing 
surface which becomes completely closed over 
with skin by the tenth to fifteenth day. In dress- 
ing the cord, it should be kept clean and dry with 



196 MATERNITY AND CHILD CARE 

boric acid, dusting powder and sterile gauze At 
the first sign of any inflammation, your physi- 
cian's attention must be called to it immediately. 

LIMBS AND FEET 

The baby's legs are bowed in appearance be- 
cause there is an actual bowing of the thigh 
bones which gradually disappears and becomes 
practically straight during the second year. Be- 
fore the baby walks, he lies with the soles of his 
feet turned inward and walks with his toes turned 
in for a long time. The foot only gradually 
comes into a correct line. Walking with the toes 
turned in leads many mothers to believe their 
babies are pigeon-toed when their feet are in 
reality perfectly normal. 

The baby's foot appears to be flat, without any 
arch. This is because many of the bones in the 
foot are not developed and do not develop com- 
pletely for several years. The foot is protected 
by thick layers of fat and it is this that gives 
the flat-foot appearance which in reality does not 
exist. It is because the little unformed foot is 
so flexible that the greatest care should be exer- 
cised in seeing that even the first stockings and 
shoes are large enough to prevent any pinching 
or binding of the foot. Many of the little bones 
are in the cartilage formation and are very easily 
twisted out of shape. 

The baby will raise up in his mother's lap, 



THE BABY'S GROWTH 197 

supported, at the age of six months. He will 
begin to creep about at seven or eight months, 
but not until he is a year old should he be en- 
couraged to stand, supporting himself by the 
chairs. Not until the fourteenth month should he 
try to take the first steps from chair to chair. 
And remember, this is dependent upon his being 
a perfectly normal healthy baby who has not 
been set back by illness or poor nutrition. If 
the baby has not been well or has been badly 
nourished, no attempt should be made to hurry 
his efforts to stand or to walk. For the bones 
in the under-nourished baby are apt not to be 
firm enough to support the body weight until the 
baby's nutrition and general condition show a 
decided improvement. 

NEBVES AND MUSCLES 

The nervous system of the young infant is 
slightly developed in so far as the baby's ability 
to control the movements of his arms and legs 
is concerned. However, the nervous system has 
reached a state of development where it has un- 
der control the general nutrition of the muscles 
through the blood supply. All of the baby's mus- 
cular movements are entirely without the control 
of the brain and are carried out without con- 
scious purpose on the baby's part. The baby's 
arms and legs should be unhampered for a cer- 
tain time each day so that this involuntary move- 



198 MATERNITY AND CHILD CARE 

ment of the muscles can be carried out. It is in 
this way that the child gets the exercise neces- 
sary to develop all the muscles and stimulate the 
general circulation. This free exercise of the 
limbs is one of the secrets of growth and develop- 
ment. The baby pinned dowii under heavy cloth- 
ing and bedding will fail to grow no matter how 
correct the food may be. 

The time when the conscious control of the 
bladder and bowel is established varies greatly 
in different children. Training helps to develop 
this conscious control much earlier. This train- 
ing for the baby's control of the bowel move- 
ments and urination can to advantage be begun 
successfully as early as the sixth month in all 
cases. 

The second month, the baby begins to hold his 
head up and by the fourth month supports it and 
turns it about quite firmly and independently. 
The very young infant grasps and holds tightly, 
but conscious reaching and grasping comes about 
the third month and not until the sixth month 
does the baby direct his movements and begin 
to knowingly play with toys. 

The growth of the baby's tissues, muscles and 
bones are dependent upon its exercise and good 
blood supply, and these in turn, are largely under 
the direct control of the nervous system. Every 
means taken by the parents to insure a quiet, 
calm, well-balanced nervous system provides the 



THE BABY'S GROWTH 199 

surest foundation for good nutrition and sound 
health. 

TEETHING 

Average 

Age The First or Temporary or "Milk" Teeth Number 

6 months Lower central incisors 2 

9 months Upper central incisors and tipper lateral 

incisors 4 

12 months Upper molars, lower lateral incisors, and 

lower molars 6 

18 months Canines 4 

24 months Second molars 4 

The coming of the first teeth varies over sev- 
eral months, appearing sometimes as early as 
the fifth and as late as the ninth month, or even 
the twelfth month, and often coming sooner in 
girl babies than in boy babies, and they drop out 
in the same order, the roots being absorbed. 

Mothers sometimes mistake the drooling that 
starts about the fourth month for the coming of 
the teeth, but this is due to the development of 
the salivary glands. You remember, that the 
reason you could not feed cereal water was the 
undeveloped condition of the salivary glands, and 
it is the saliva that starts the digestion of 
starch. 

The twenty first-teeth usually erupt in pairs. 
When the teeth are backward it may be due to 
lack of some of the nourishing elements in the 
milk, and you had better carefully weigh your 
baby each week to see if it is making the proper 
gains. Teething is a perfectly natural process 
and should not cause the baby much disturbance. 



200 MATERNITY AND CHILD CARE 

If he is restless and fretful it is very often apt 
to be due to other causes. Don't dismiss it with 
the thought that "the baby is just teething. " 
See if he is getting too much or too little milk, 
if he is sleeping properly, has plenty of fresh air 
and exercise and is not handled too much. 

When the gums become swollen and painful, 
gently rub over them a small piece of clean ice 
wrapped in a perfectly clean handkerchief. Three 
or four drops of paragoric on a clean piece of 
gauze can be rubbed over the gums. Biting on 
an ivory ring gives some relief. Frequent sips 
of cool water cool the gums. 

It is a wise plan to cut down the amount of 
food a little if teething upsets the digestion, and 
if it becames very troublesome consult your 
doctor. 

DIET FROM FIRST YEAR TO 18 MONTHS 

Breakfast: Bottle, or eight to ten ounces of milk with 

a little toast, zwieback or two-day bread 
broken into it, or two to three tablespoon- 
fuls of oatmeal (cooked three hours), or 
hominy, or cream of wheat thoroughly 
cooked into an unstrained porridge, with 
six to eight ounces of milk poured over it. 

9 A. M. Juice of one orange, or baked apple, or apple 

sauce, or mashed prunes, given one hour 
before the 10 o'clock feeding. 

10 A. M. Eight or ten ounces of milk from cup or 

bottle, or if only the bottle is given at 
the first feeding, give the cereal at this 
feeding. 
1:30 to 2 P. M. Eight or ten ounces of mutton or chicken 
broth which has been cooked with some 
cereal, such as, rice, barley, farina or 
oatmeal; and with this a small amount of 
mashed vegetable, such as spinach, peas, 



THE BABY'S GROWTH 201 

potatoes or carrots, put through a seive 
to have the consistency of fine gruel be- 
fore being added to the soup. Also a 
piece of buttered toast, and for dessert, 
apple sauce, prune pulp or other stewed 
fruits. 

Another midday meal consists of two-day- 
old bread moistened with beef or chicken 
dish-gravy, beef tea, or one or two ounces 
of beef juice, also one cup of milk. 

Another meal consists of rice or grits mois- 
tened in the same way, and six to eight 
ounces of milk with a dessert of sago, 
tapioca or rice pudding (no raisins) or 
junket or cornstarch pudding. Serve no 
more than two tablespoons of either of 
these desserts. 
Supper: Eight to ten ounces of milk, or two thin 

5 to 6 P. M. slices of two-day bread with six to eight 

ounces of milk poured over it. Sugar 
used very sparingly, if sweetened. 

9 to 10 P. M. Eight to ten ounces of milk from cup or 

bottle. 

Note: Milk should not be given cold. This diet represents 
the maximum amount given a child of this age. Many thrive 
on much less. Water should be given freely between meals, 
but milk should not be given except as mentioned. The 
child's teeth at this age do very little chewing, therefore the 
foods should be carefully mashed. If you give less than the 
quantity of food prescribed in this diet, do not cut down 
the variety. 

DIET FROM 18 MONTHS TO TWO YEARS 

Breakfast: Eight ounces of milk with a slice of but- 

tered toast or two-day-old bread, or an 
oatmeal or graham cracker. 
Another breakfast consists of two to three 
tablespoonfuls of oatmeal (cooked three 
hours) or any of the other cereals men- 
tioned in the last diet, with six or eight 
ounces of milk poured over. 
Another breakfast consists of a soft-boiled 
or poached egg with bread and butter and 
six to eight ounces of milk. 

A. M. Fruit juice, same as in former diet. 

10 A. M. Six to eight ounces of milk with bread, or 

bread and butter, or buttered graham 
cracker. 



202 



MATERNITY AND CHILD CARE 



Dinner: Boiled rice, or a baked potato mashed and 

1:30 to 2 P. M. moistened with chicken or beef gravy or 

beef juice, with six ounces of milk, and 

dessert. 
Another dinner: One-half to one tablespoon- 

ful of spinach, or string beans or peas or 

asparagus tips or carrots, mashed, with 

six ounces of milk. 
Another dinner: Six ounces of mutton or 

chicken broth cooked with barley or rice. 

The finely divided meat fibre can be left 

in the soup. Add a piece of bread and 

butter and dessert. 
Another dinner: Two or three teaspoonfuls 

of scraped beef or mutton, or minced white 

meat of chicken with eight ounces of milk 

and dessert. 
Desserts should consist of plain sago or rice 

pudding without raisins, a baked apple or 

a few stewed prunes. Desserts should not 

be given in the same meal with green 

vegetables. 
Supper: Bread and milk, six to eight ounces, or 

5 to 6 P. M. milk with graham cracker or toast or 

zwieback, or bread and butter. 
Another supper: Two or three tablespoon- 

fuls of oatmeal or other cereal porridge 

with eight ounces of milk. 
Note: The child of one to two years should not receive 
more than twenty-four to thirty-two ounces of milk a day. 
It is important that the diet should include other foods, such 
as those just mentioned, but in cutting down the milk, the 
baby requires more liquid and this should be supplied by 
giving plenty of water between meals. This diet is sufficient 
for a hearty child. The average baby will thrive on smaller 
amounts of the same variety of foods. 

DIET FROM SECOND TO THIRD YEAR 



Breakfast: Three tablespoonfuls of well-cooked cereal 

with cup of milk, in addition to the milk 
poured over the cereal or two to four 
ounces of cream on the cereal. 
Another breakfast: One soft-boiled or 
poached egg with piece of bread and but- 
ter and cup of milk. A little hashed 
chicken can be substituted for the egg, 
and a bran biscuit for the bread. 

10 A. M. Juice of an orange, or baked apple. 



THE BABY'S GROWTH 



203 



Noon-meal: Portion of strained soup or broth (not 

greasy) with a small piece of beef -steak, 
roast beef, chicken (white meat) or fish 
(the bones carefully removed), and a por- 
tion of baked potato or macaroni or rice. 
Small portions of such other vegetables 
as peas, string-beans, squash, mashed cauli- 
flower, strained stewed tomatoes, stewed 
carrots, spinach and asparagus tips can 
be judiciously added to the diet. A piece 
of bread and butter with plain dessert 
should complete the dinner, with water 
to drink instead of milk. 

3 to 3:30 P. M. Most children thrive best on three meals, 
but if the child is a small eater and re- 
quires something at this time, give a cup 
of milk and graham cracker, or a cup or 
broth and piece of zweiback, or a scraped 
raw apple or pear, giving the fruit espe- 
cially if there is constipation. Children 
convalescing from illness need this extra 
nourishment in the middle of the after- 
noon. 

Supper: Bread and butter and a cup of milk. 

6 P. M. Another meal: Bread or graham or oat- 

meal crackers and milk. 
Another meal: Three to four tablespoonfuls 
of cereal porridge with eight ounces of 
milk. 



If the child sits at table, never start giving him 
articles of food from the diet of the older chil- 
dren, and he will not begin to ask for them. 
Meals should be at regular hours. Deviation 
from the usual time throws the digestion out of 
order. There is more danger of over-feeding 
than under-feeding. Do not give any highly sea- 
soned food or left-over dishes. The chief meal 
should be at noon and the evening meal light. 
Meat only once a day and in some children only 
three times a week if it does not seem to agree. 



204 MATERNITY AND CHILD CARE 

Never give coffee or tea or chocolate, and cocoa 
only rarely if it is not too rich. Cream, if given, 
should be used in small amounts. Avoid all un- 
cooked vegetables and give raw fruits except 
orange juice and scraped apple very cautiously, 
if at all. Avoid all cold foods and never give ice 
cold milk or water. A little ice cream eaten 
slowly and fed in tiny morsels can be occasionally 
given. Avoid all sweets, candies, cakes; and 
never permit pastry of any kind. A piece of 
candy may be given with the meal — not between 
meals. Never allow hot rolls or fresh bread or 
biscuit or fried cakes. 

The diet for the sick baby is described in the 
volume, The Proper Feeding of Infants. 



CHAPTER XVII 
THE FORMATIVE YEARS 

THE NEGLECTED AGE 

The years of childhood between three and 
seven comprise The Formative Age. Other des- 
ignations have been made, such as, the Pre- 
school Age and the Neglected Age. I believe 
the word, neglected, applies to this period in the 
life of the average child with peculiar precision. 

I desire very much to enumerate to you my 
reasons for referring to these formative years 
as The Neglected Age. There are, indeed, many 
explanations for the use of this term, and while 
they do not all apply in any one instance, some 
of them are factors which enter into the daily 
life of nearly every family. 

First, I wish to emphasize why it is of such 
vital importance to the future life of the child 
that these years be the most carefully guarded 
instead of the neglected ones. During this period 
it is of far-reaching importance that the proper 
foods be insisted upon because cell growth and 
development are going on with unbelievable 
rapidity. 

205 



206 MATERNITY AND CHILD CARE 

Preparation for school-life at this time is daily 
advancing. The child who enters school at the 
age of six of seven below the average standard 
of his fellow schoolmates almost invariably drops 
behind in his studies, and what is even more un- 
fortunate, the child entering school with a physi- 
cal handicap, finds great difficulty in overcoming 
it. The school program is mapped out for the 
average, healthy, normal pupil and the child 
physically weakened by improper care during the 
pre-school age is under too great a strain in his 
effort to keep pace with his classmates. 

We have still another reason which outranks 
this in importance. If the rapidly growing child 
during this period fails to receive the proper kind 
of food to meet the cell requirements of the body 
as they pass swiftly from one development to 
another, the tissues which these cells compose 
fail to receive the right nourishment to make 
strong organs and muscles. They are, conse- 
quently, weak and flabby. Their resistance 
against disease is far below normal. Such a 
child readily falls a prey to any of the infectious 
diseases so prevalent during the winter and 
spring months. With weak, soft and undersized 
muscles all such children in entering upon the 
daily games and outdoor exercises of their fel- 
low playmates are prone to overtax their 
strength. They fatigue easily and will come in 
from play utterly exhausted, either pale or with 



THE FORMATIVE YEARS 207 

an unnatural flush, with dark circles beneath the 
eyes, and usually with little or no appetite. 

You would be amazed at times if you would 
take the temperature of one of these children 
after hearty exercise. It is not uncommon to 
find half a degree, a degree and sometimes two 
degrees of fever. The child has used up its small 
reserve energy and this temperature means no 
less than that the normal tissues of the body are 
being broken down and burned up to supply the 
necessary vitality to keep the child going. 

Unfortunately many parents overlook this im- 
portant sign, masked, as it often is, by childish 
excitement and the unnatural flush of the cheeks. 
But if you will only stop to consider, it will 
many times explain why your child is nervous, 
has a poor appetite, sleeps badly, fails to gain 
properly in weight, and continuously remains be- 
low normal despite all the other efforts you put 
forth. 

There is another type of nervous child, made 
so, not by neglect, but by an equally serious error, 
that of over-attention. This, as a rule, begins 
during the formative years. It is commonly 
given to what we call the precocious child, the 
one whose mind seems to be developed beyond 
its years. 

Many parents and some teachers have an un- 
fortunate habit of trying to show these children 
off in the presence of company. They are en- 



208 MATERNITY AND CHILD CARE 

couraged to memorize long recitations, and urged 
before audiences under conditions of great nerv- 
ous excitement. Some of these little tots are 
early taught to dance fancy steps, or to perform 
on some musical instrument under the same try- 
ing conditions. If you will observe attentively 
one of these children performing some feat be- 
yond its years, you will readily notice the great 
emotional excitement under which the little one 
labors, and the reaction of mental and physical 
exhaustion which inevitably follows. 

All of these nervous children suffer from an 
habitual loss of appetite. They are what we call, 
finical or notional eaters. They toss about and 
are restless in sleep and soon develop unmistak- 
able signs of malnutrition. 

The age of from three to seven can be aptly 
called, "The Neglected Age," in many families 
where there are other children. Especially is 
this true if the mother has older % children who 
must be prepared daily for school. Their clothes 
and books and lunches take up so much of her 
time that attention to the little tot who does not 
go to school is too often sadly omitted. The 
danger of this neglect becoming more serious is 
only further enhanced if there is added the fur- 
ther responsibility brought about when there is 
a young baby in the family. 

Never lose sight of the little one during the 
run-about age! His food, his clothes and his 



THE FORMATIVE YEARS 200 

fresh air are of as vital importance as they will 
be at any time during his life. 

I believe that a warning ought to be given to 
many mothers concerning a habit which so easily 
develops and for which a busy mother should not 
be criticised. It is a very natural reaction fol- 
lowing the first or second year of the baby's life 
during that time when she has had to be con- 
stantly watchful of every ounce of his food with 
the attendant care and supervision which have 
been so essential day by day. When the time 
comes that the baby is able to sit at table and 
partake of other articles of food besides milk, 
the mother is apt to become forgetful of the im- 
portance of properly choosing his food. Others 
oftentimes interfere^ with her discipline, because 
many people have the foolish idea that when a 
child's teeth have made their appearance he is 
able to eat practically everything. 

One of the most difficult problems that you as 
a mother encounter is in getting certain children 
to eat the proper kinds of foods. This is a habit 
which easily develops during the neglected age. 
You will encounter it in the nervous child and 
in the sympathetic and impressionable child. 

You have had the opportunity of observing 
from time to time many of these children. The 
mother will tell you that it is impossible to get 
her child to eat this or that essential food. She 
will add that only certain things will be taken 



210 MATERNITY AND CHILD CARE 

by the child, oftentimes only milk or sweets, or 
cereals, or in some cases, only meat and potatoes, 
practically all vegetables being refused. 

The first step with such a child is to correct, 
as I have already pointed out, the cause for the 
nervousness, if it is due to physical exhaustion 
from too much play or too much excitement. This 
can be accomplished with a little persistence. 
Make your child lie down for one or two hours 
after the mid-day meal, even if he does not go 
to sleep. Insist upon establishing the habit. Put 
the child in a room with lots of fresh air and 
sufficient covering. You will be surprised to see 
how soon the habit of taking the regular noonday 
nap will develop. This short rest in the middle 
of the day is almost invariably followed by a 
marked and prompt improvement in the child's 
nutrition. 

Do not allow your child to play too hard or 
too long. If you find the daily recreation is mak- 
ing him nervous or exhausted, it can easily be 
limited. And if your child is one of the preco- 
cious, unusually intelligent little ones, it is all 
right to have him speak short pieces before com- 
pany, occasionally, but do not tax the little brain 
with long, tedious recitations or physically ex- 
hausting dancing or the performance of unusual 
feats on the piano. These little overtaxed nerv- 
ous systems demand a terrible physical toll which 
is unfailingly taken in the later years. These 



THE FORMATIVE YEARS 211 

children inevitably grow up to be pale, under- 
nourished, nervous sickly young men and women. 

Many childish preferences of diet are due to 
no other cause than a desire to imitate older peo- 
ple, or to impressions received from careless con- 
versation among grown-ups. The child mind re- 
ceives the suggestion from the older members of 
the family that certain foods are unpalatable and 
certain foods are indigestible. Children are great 
imitators. They are very fond of doing what 
their elders do. Rather impress upon the child's 
mind that the necessary foods are the good foods, 
that their bodies need these very foods in order 
that they may grow up to be strong, successful 
men or beautiful and charming women. 

There is another way in which a mother, un- 
less she is always watchful, is prone to neglect 
unconsciously these children of the formative 
age. Because they are old enough to play about 
the house and amuse themselves, busy mothers 
fail to realize that these children must be bundled 
up and taken out into the fresh air every day 
just the same as when they were babies. Even 
in pleasant winter weather do not fail in this 
daily airing. Dress them warmly and let them 
play out in the snow every day. The child 
warmly clothed will not want to come in the 
house and these are the children who have the 
natural rosy cheeks and grow into strong, healthy 
boys and girls. 



212 MATERNITY AND CHILD CARE . 

The question you are now asking is: What 
foods should I be giving my child during these 
pre-school years ? and, a question of equal impor- 
tance, What foods should I not allow him to eat? 
Before I supply you with the tables which will 
guide you in this matter of diet, I want to empha- 
size a few words of caution. 

In the first place, do not allow constipation to 
exist! A daily evacuation of the bowels should 
never be overlooked. You should begin early in 
life, before your child is even a year old, to take 
him to the toilet at a regular hour each morning. 

There is much that can be done in the way 
of diet to overcome habitual constipation and 
this big subject is discussed in a later chapter. 
Briefly let me say that fruit juices, cooked fruits, 
whole wheat bread and well cooked vegetables 
should correct the difficulty entirely without any 
unnatural aids. 

Be very cautious about giving drugs to your 
children for the correction of constipation. It 
leads only to the necessity of continued usage. 
The much safer method for you to follow, if the 
constipation becomes persistent, is to use one or 
two, or even three, teaspoonfuls of one of the 
mineral oils at bedtime. These oils are not ab- 
sorbed, as are the drugs. They merely act as a 
lubricant and their tendency is to permanently 
correct constipation. 

Another caution which I desire to make is the 



THE FORMATIVE YEARS 213 

careless habit of allowing children to eat between 
meals. This in my opinion is a most reckless 
practice. The stomach forms habits of receiving 
foods at regular intervals and interruption of 
these habits by irregular eating invariably leads 
to serious indigestion. 

Another warning is in regard to the use of 
milk. Milk is a valuable food and necessary for 
the growing child. But during the run-about 
age, from fifteen months on to the sixth or sev- 
enth year, mothers oftentimes err in allowing 
children too much milk to drink. It destroys the 
appetite for other very necessary foods. These 
children should receive three to four cups of milk 
a day at meals either as a drink or poured over 
the cereal and other foods. This is equivalent 
to twenty-four to thirty-two ounces. And this 
is also a fact to be remembered : the cream or fat 
in milk is not well bourne by some children dur- 
ing these preparatory years. It repeatedly 
causes coated tongue, foul breath, a loss of appe- 
tite and an obstinate form of constipation. When 
this occurs try for several days the use of 
skimmed milk. These symptoms will then 
usually disappear. 

The following diet suggestions must, of neces- 
sity, be made in a general way. Changes will 
need to be instituted in individual cases because 
unusual conditions will arise which require spe- 
cial diets. These are the foods, however, which 



214 MATERNITY AND CHILD CARE 

can be safely taken by the normal, healthy child 
between the ages of three and seven years. 

All rich, highly seasoned dishes are to be 
avoided. Milk must still form a very prominent 
article of diet. The child should receive from 
three to four cups a day. This amount includes 
milk which is used on cereals and other foods. 
Cream should be employed with great caution 
and in small quantity. (If the milk is obtained 
from Jersey or Guernsey cows, and the child has 
any of the symptoms mentioned above, half of the 
cream from the milk should be removed.) The 
heartiest meal should be given in the middle of 
the day. The supper should be light. Meat 
should never be eaten more than once a day ex- 
cept for some special reason. (It is my opinion 
that before the fifth year the use of meat three 
or four times a week is sufficient.) 

DIET FKOM THIKD TO SEVENTH YEAR 

Table A — Safe Foods for Daily Diet 

Meats. — Broiled beefsteak, lamb chop and chick- 
en; roasted or boiled beef, mutton, lamb, 
chicken and turkey ; broiled or boiled strictly 
fresh fish; crisp bacon. 

Eggs. — Soft-boiled, poached, scrambled, ome- 
lette. (One egg for breakfast; one for sup- 
per; not more than two a day.) 

Butter. — Good butter should be used liberally. 

Cereal Foods. — Light wheaten and graham 



THE FORMATIVE YEARS 215 

bread, (two or three clays old) toast, zwie- 
back; plain unsweetened biscuit, such, as oat- 
meal, Graham, soda, water, etc.; hominy 
grits, wheaten grits, cornmeal, barley, rice, 
oatmeal, macaroni etc. 

Soups. — Meat broths and vegetable soups of 
nearly every kind. 

Vegetables. — White potatoes, thoroughly cooked 
and mealy, baked, boiled and mashed may 
be given daily. Don't include sweet potatoes 
and fried potatoes. Peas, spinach, young 
greens, carrots, asparagus (except the hard 
parts), string beans, young lima beans boiled 
and well mashed. (Not baked beans.) Sal- 
sify, lettuce, stewed celery, young beets, ar- 
rowroot, tapioca, sago. The standard brands 
of canned vegetables when fresh green vege- 
tables are not obtainable. 

Fruits. — Cooked fruits of all the common varie- 
ties, sweetened and having the skins and 
seeds removed. Plain jellies. Oranges, 
scraped apples, peaches and pears when well- 
ripened. The juices only of strawberries, 
raspberries, blackberries, pineapple. 

Desserts. — Light, plain puddings only, such as 
rice pudding without raisins, bread pudding, 
cornstarch, Indian pudding, or farina, baked 
custards, junket, jello, occasionally ice cream. 
Only plain cake such as a piece of light 
sponge cake and well-baked cookies of the 



216 MATERNITY AND CHILD CARE 

plainest varieties without raisins or eocoannt 
or much sweetening. 

Beverages. — Milk and water only. Milk to be 
taken only with meals serving as both food 
and beverage. Water to be taken freely be- 
tween meals. 

Table B — Foods To Be Avoided 

Meats. — Pork, sausage, ham, goose, veal, corned- 
beef, liver, kidney; all dried and salted 
meats; rich thickened gravies; all fish that 
is not strictly fresh; all fried meats and 
fried fish. 

Eggs. — Fried eggs, hard boiled eggs (except the 
yolk that has been finely grated), fancy ome- 
lettes or souffles, and all eggs not strictly 
fresh. 

Breadstuffs. — All fresh bread, hot rolls, biscuits, 
pancakes and buckwheat cakes; doughnuts, 
anything heavy or doughy, or fried. 

Soups. — All rich greasy soups. Tomato soup. 

Vegetables. — Sweet potatoes, raw tomatoes, rad- 
ishes, cucumbers ; pickled vegetables, such as 
onions, slaw, gherkins; celery, corn of any 
kind (excepting cornmeal) ; old beets, cab- 
bage, egg plant, cauliflower, and all vegeta- 
bles not thoroughly cooked. 

Salads. — Salads of all kinds should be avoided 
as they are not easy of digestion. 

Fruits. — All u-nripe, sour or wilted fruit; ba- 
nanas, cherries, plums, pineapples, grape- 



THE FORMATIVE YEARS 217 

fruit, lemons and all raw fruits with seeds; 
melons, unless strictly ripe and then only 
sparingly. All over-ripe fruit; spiced jams, 
very sweet jellies and all rich conserves and 
dried fruits. Avoid skins, seeds, stones or 
tough pulp. 

Desserts. — All pastry, pies, tarts ; rich puddings 
and cakes; sweet cookies, candies, nuts and 
raisins; preserved or candied fruits; cheese. 

Beverages. — -Avoid tea, coffee, rich chocolate, 
lemonade, cider, soda-water, etc. 



CHAPTEE XVIII 
TEACHING HEALTH TO THE SCHOOL CHILD 

The physical health of the child comes first. 
Every parent should realize that this is the great- 
est financial investment, for the days to come. 
It is the small trouble overlooked in the beginning 
that grows into big doctor bills and chronic 
invalidism. Health is a matter of habit. The 
mother who realizes this even without the fa- 
ther's aid or the helpful medical inspection of 
the schools, can herself accomplish great things 
for her child. She should not be compelled to 
work alone, however, but should have the co-oper- 
ation of all the family, her physician, the Board 
of Health, her Woman's Club, Church and 
School. 

The father is interested when he realizes that 
health in his boys means strength and efficiency. 
The mother, when she knows that health in her 
daughters means happiness and the grace of 
fully realized womanhood. All are interested 
when they appreciate that health results in capa- 
ble contented children. 

The boy can be made appreciative of health 
because he wants to become a great athlete or 

218 



TEACHING HEALTH 219 

successful in business or politics. The strain 
of competition is so great that to do this a boy 
must have strong vital organs. 

The girl desires beauty, shapeliness, clear skin 
and good color, which can only be had through 
health. 

You must tell the young child what to do. To 
the older children you should tell why. They 
must be taught early that health is a matter of 
the daily care of the body, that it is not a gift 
of nature. The proper care of the body makes 
the weak at the start, strong in the end. The 
failure to take this, will make the strong at the 
start, weak in the end. Roosevelt was a weak 
and sickly boy. Right living in the open, good 
food, proper exercise, and the will to do it made 
him a mental and physical giant. 

Health must be taught in the home, the school, 
on the playground, during vacation, at church 
and in all public entertainment. By showing the 
children the results of good health each child 
can be made to follow every rule willingly that 
he too may become sound and capable in mind 
and body, that he may serve his parents, his 
country and himself to his fullest possibility. 

THE RULES OF HEALTH 

Remember, everything in nature which grows 
throws off waste. The body in growing throws 
off waste matter which is poison to it and must 



220 MATERNITY AND CHILD CARE 

be gotten rid of. This expelling of waste goes 
on through the bowels, the kidneys, the lungs and 
the skin. Each one of these organs must rid the 
body of its share of waste daily or a slow poison- 
ing takes place. 

Care of the Skin. — Every square inch of the 
skin is filled with little sweat glands. If all of 
these glands of your body were placed end to 
end they would make a procession eight miles 
long. Each day these glands pour out on the 
skin nearly one pint of water which has poison- 
ous waste dissolved in it. The mouths of these 
glands must be kept open. If the waste matter 
dries and accumulates on the skin the mouths 
are stopped and the pores are clogged. You 
remember the actual case of the boy whose body 
was covered with gold leaf for an entertainment. 
The mouths of all the sweat glands of the skin 
were closed, his body could not get rid of the 
poisons through the skin, he was taken ill and 
died in a few hours. 

The child should be taught early the reason 
for the daily bath of soap and warm water, that 
the mouths of the pores may be opened and the 
refuse be washed away. With most children 
after the warm bath the cool sponge can be given, 
especially around the neck and chest. This is 
invigorating and has a splendid effect upon nerv- 
ous children. Some children do not react well 
to the cool water. Those who take cold easily 



TEACHING HEALTH 221 

had better bathe at night. If bathed in the day- 
time, they should not go outdoors for ar hour. 
After the bath the skin should be rubbed briskly 
with a rough bath towel which brings a warm 
red glow of blood to the surface and has a splen- 
did effect upon the circulation as well as the nerv- 
ous system. 

If after using the cool sponge the skin remains 
pale or bluish and the child feels cold and de- 
pressed it should be promptly discontinued. 
Never give a cool sponge to a delicate child ex- 
cept on the physician's advice. And remember, 
the cool sponge bath should not last more than 
three minutes. The warm bath should not be 
longer than five minutes and there should never 
be a hot bath unless the physician directs its 
use. It is exhausting, produces excessive sweat- 
ing and endangers the child to cold. The tem- 
perature of the warm bath should be about that 
of the body. There are times when the bath a 
little warmer than the body temperature given 
just before bedtime will quiet the nervous, rest- 
less child and insure a good night's sleep. 

Children who go in swimming should remain 
no longer than fifteen or twenty minutes because 
the water which is so much cooler than the body 
chills the skin, and the child who remains in 
longer than this does not react and the blood is 
driven to the deeper organs which has a very de- 
pressing effect. 



222 MATERNITY AND CHILD CARE 

The early care of the hair and scalp are im- 
portant. Dirt and germs in great quantities ac- 
cumulate around the roots of the hair. The 
scalp can quickly get into an unhealthy state with 
actual sores and infections in which pus forms. 
A dirty scalp is an unhealthy scalp, and on an 
unhealthy scalp the hair cannot grow properly. 
The child should be early taught the need of a 
thorough shampoo once a week. An abundant 
lather of tar soap or green soap rubbed into 
the roots of the hair for several minutes and then 
rinsed with warm water to remove all of the 
soap and dirt, and rinsed again with cool water 
to stimulate the scalp, is a weekly routine that 
will keep the hair and scalp in healthy condition. 
Excessive scales or dandruff may make it advis- 
able to give the shampoo twice a week, with an 
after-massage of salicylic acid vasogen rubbed 
well into the scalp. 

The nails should be kept trimmed, and cleaned 
by the use of a stiff nail-brush because all sorts 
of dirt and germs accumulate beneath them. The 
child should not only wash his hands, but clean 
his finger-nails before eating. Dirty finger-nails 
actually carry disease germs to the food and into 
the mouth. Clean finger-nails are a sign of good 
breeding. 

Care of the Teeth. — Enough cannot be said on 
this subject. The story of the milk-teeth has al- 
ready been told you in the chapter on The Baby's 



TEACHING HEALTH 223 

Hygiene. The permanent teeth begin to make 
their appearance about the seventh year. The 
first four molars called the six-year molars, par- 
ents must remember, are permanent teeth and 
must not be mistaken, as they often are, for 
temporary teeth, and pulled because of a cavity. 
No teeth come in their place and if they are 
pulled a permanent gap is left, which as you 
know, not only interferes with the shape of the 
jaw hut mastication of the food and digestion. 
In a recent meeting of dentists it was disclosed 
how parents had frequently let one or two, or 
even the four first molars be sacrificed, because 
appearing at the sixth year they had been mis- 
taken for delayed temporary teeth. 

In the chapter on The Baby's Hygiene we have 
already learned the importance of starting early 
to care for the temporary teeth. These tempor- 
ary teeth must not be allowed to decay. If these 
teeth decay and become infected from neglect, 
this infection extends through the gums to the 
permanent teeth pushing their way out beneath 
them. 

It has been well said, that if a child's mouth 
receives careful attention, the services of a physi- 
cian will rarely be needed for any other part of 
the body. 

If infection gets into the teeth or around the 
gums it can cause just as disastrous results in 
producing disease as an infection of the tonsils. 



224 MATERNITY AND CHILD CARE 

Rheumatism, diseases of the joint, heart disease, 
anemia, malnutrition, and some of the more seri- 
ous types of nervous diseases, such as intractable 
headaches, muscle spasms, St. Vitus' Dance, and 
even epilepsy, have been repeatedly traced to in- 
fections around the gums and roots of the teeth. 

Now let us study the various ways in which 
the teeth decay and the roots and gums become 
infected. First, there is the neglect of the tooth- 
brush and failure to keep the teeth clean. The 
child must be taught the advantage of brushing 
the teeth after each meal, or at least once a day. 
He must understand that particles of food that 
get between the teeth ferment causing the enamel 
to break down and painful cavities to form. The 
child who does not have the proper diet suffers 
from malnutrition and often one of its first mani- 
festations is decaying teeth. The child allowed 
to eat an excessive amount of candy and sweets 
is the one who so commonly is subject to bad 
teeth. Particles of candy adhering to the teeth 
rapidly ferment and cause decay. Moreover, 
candy-eating upsets the stomach, throws nutri- 
tion out of balance and this interferes with the 
development of the teeth. 

From unclean food, from dirt carried on the 
hands to the food and into the mouth, from de- 
composing food between the teeth or in cavities, 
infection gets into the gums around the teeth. 
This is called Rigg's Disease. Infection also 



TEACHING HEALTH 225 

travels from cavities in the teeth and from 
around the teeth to the roots, and there forms 
what is known as blind abscesses which are not 
painful, the child or grown person being entirely 
unconscious of them until the health becomes 
undermined from the poisons absorbed into the 
blood from them. These can only be detected by 
the X-ray photograph which can now be had in 
practically every good-sized town in the United 
States. 

Because the teeth are close to the tonsils, infec- 
tions of the gums readily extend to the tonsils 
and are also carried by the little lymphatic chan- 
nels to the glands of the neck, causing them to 
become infected and enlarged. 

The child must early learn to use dental floss, 
which can be purchased in any drug store, to 
remove all particles of food from between the 
teeth each day, as regularly as the tooth-brush 
is used. After each brushing, the mouth should 
be thoroughly rinsed, using a glass of water in 
which is dissolved a teaspoonful of table salt. 
This has three purposes, it rinses out the parti- 
cles of food removed from the crevices of the 
teeth by the brush and the dental floss ; it hardens 
the gums; and it stimulates them, protecting 
against infection. 

Every six months your child's teeth should be 
looked over by a competent dentist, any little 
cavities promptly filled, and the teeth thoroughly 



226 MATERNITY AND CHILD CARE 

cleaned and scaled of all accumulations. These 
hardened accumulations have been observed in 
the mouths of some children to such an extent 
as to actually interfere with the proper closing 
of the jaws, thus causing the bolting of unmasti- 
cated food. 




Diagram showing- the Permanent Teeth, a — Central Incisors, 
b — Lateral Incisors, c — Canines, d — First Bicuspids. 
e — Second Bicuspids, f — First Molars, g — Sec- 
ond Molars. h — Third Molars. 

The permanent teeth come in crooked at times. 
You must never fail to have them straightened 
by your dentist, held by braces until they have 
grown into the correct position. Crooked teeth 
deform the mouth and greatly lessen your child's 
personal appearance. 

Do not be in a hurry to pull the temporary 
teeth; they are loosened and pushed out by the 
incoming permanent teeth. The latter make 
their appearance in the order shown in the fol- 
lowing table. 

Eruption of the Permanent Teeth. — The per- 
manent teeth are thirty-two in number. The ear- 



TEACHING HEALTH 227 

liest ones cut are the first molars which come in 
just back of the temporary second molars. They 
appear about the age of six and are called "the 
six-year-old molars/ ' The order and dates of 
appearing are subject to considerable variation. 

4 First molars (2 upper and 2 lower) 5 to 7 years 

4 Central incisors (2 upper and 2 lower) 7 to 8 years 

4 Lateral incisors (2 upper and 2 lower) 8 to 9 years 

4 First bicuspids (2 upper and 2 lower) 9 to 10 years 

4 Second bicuspids (2 upper and 2 lower) 10 to 14 years 

4 Canines (2 upper and 2 lower) 11 to 13 years 

4 Second molars (2 upper and 2 lower) 13 to 16 years 

4 Last molars (wisdom teeth) (2 upper and 2 

lower) . . .16 to 25 years 

FKESH AIR 

The air we breathe contains oxygen, nitrogen 
and very small amounts of carbonic acid gas, 
ozone and argon. Oxygen is the element upon 
which life depends. The air we breathe out con- 
tains less oxygen and more carbonic acid gas. 
Our blood has given off the latter, which is one 
of our poisonous body wastes, and has taken up 
quantities of oxygen. Pure air, to be fit for 
breathing, must not contain more than ten parts 
carbonic acid gas to every ten thousand parts air. 
In the average size sleeping-room one person 
breathes out in two hours enough carbonic acid 
gas to render the air of the room unfit for further 
breathing. Therefore, it is plainly seen that 
every sleeping-room must have a sufficient outlet 
to allow every bit of air to escape every two 
hours during the night and a sufficient opening to 



228 MATERNITY AND CHILD CARE 

allow the room to fill tip completely with fresh 
air every two hours. If there are two people 
asleep in the same room the air will be unfit for 
further breathing after one hour. And people 
moving about throw off more poisonous carbonic 
acid gas in proportion to the violence of their 
exercise. In improperly ventilated sleeping or 
living rooms we become drowsy, pale and listless. 
The brain refuses to work ; all our organs become 
loaded with this poisonous gas and fail to do 
their work correctly. The bowels become slug- 
gish and constipated. The appetite is poor. 
Nutrition suffers. The child's resistance to all 
diseases is lowered. 

A child who is forced to breath impure air, 
catches cold readily, has frequent attacks of ton- 
silitis, the adenoids enlarge, the infection travels 
down the bronchial tubes and sets up a chronic 
bronchitis, followed by tuberculosis or the dan- 
gerously acute disease of pneumonia. The blood 
becomes thin and the child pale. 

Many mothers think the child gets sufficient 
fresh air out of doors through the day so that 
ventilation of the living and sleeping rooms is 
not essential. Let me answer that the child to 
be well has got to have fresh air every moment. 
The body is using oxygen every time the heart 
beats and is breathing out carbonic acid gas with 
every breath. The child has got to have fresh 
air in the school-room, in the play-room, in the 



TEACHING HEALTH 229 

sleeping-room, in fact, wherever lie is. Don't 
think that cold air is necessarily fresh air. 

Put up your child's windows at night. Don't 
have the bed in a draught. Cover him warmly 
but not too heavily. See how well he will sleep 
with these measures, how his appetite and ap- 
pearance will improve. How soon he will stop 
having repeated colds. And don't forget about 
the sunlight in the rooms during the day. The 
direct rays of the sun kill more disease germs 
than any other disinfectant we know about. 

In our largest cities we have open air schools 
for the pale, under-weight, anemic and nervous 
children, and those with enlarged glands. Bun- 
dled up in coats, sweaters, caps and mittens, 
these children remain out of doors in their open 
air school rooms all day. These schools have 
been in operation for some time and their mar- 
velous benefits to these delicate children amaze 
those who give it a moment's thought. 

I want to add a word of caution to those moth- 
ers whose children are sickly and who live where 
they cannot have the advantages of the open air 
school. The child's health comes first — before 
books. Keep your weak or nervous child out 
of the crowded school-room until his health 
has been built up. Bundle him up and keep him 
out of doors until his health and resistance is 
such that it is safe to send him to school to stand 
exposure to the diseases of childhood. 



230 MATERNITY AND CHILD CARE 

CARE OF THE BOWELS 

Practically all the nourishment in the food we 
eat is taken up by the blood in the intestines. 
All food leaves some refuse which is of no value 
as nourishment. This must be gotten rid of be- 
cause all along the lining of the intestines live 
bacteria which attack this residue and cause it 
to decompose if it is left there too long. More- 
over, the poisonous material and gases thrown 
off from this decomposing mass in the bowels 
become absorbed by the blood and carried to all 
the organs of the body. This is rank poison and 
it can foster nearly every disease known to 
man if allowed to accumulate. It can quickly 
counteract all the good effects of proper food, 
correct hygiene and fresh air. 

The child must be taught in the earliest years 
that the bowels must be completely emptied each 
day so that no refuse is left in the body to decay 
and decompose. The mother can easily make an 
object lesson, by pointing out some decaying food 
that has been carelessly left outside, and explain- 
ing to the child in a way he will never forget, 
how this same process goes on in the bowels and 
how bacteria are actual tiny living things that 
multiply with frightful rapidity. 

You taught your child early that the bowels 
like every other organ in the body soon develop 
habits. You demonstrated to him that when you 
put him on his chamber at a certain time each 



TEACHING HEALTH 231 

day the bowels soon formed the habit of moving 
at that time. 

The drinking of five or six glasses of water 
each day is not only important in keeping the 
bowels active but in aiding the kidneys to carry 
off their share of waste properly. And it is 
through the kidneys that a large amount of the 
poisons are daily excreted in the urine. 

The diet is the first means to employ in over- 
coming constipation and this is taken up in the 
final chapter. 

SLEEP 

Every moment the child is active, energy 
and some of the tissues of the body are being 
used up. Every moment he is asleep these tis- 
sues are being built up again and energy is 
being stored for the next day. The body of the 
active, growing child needs long hours of rest 
for growth. The child under six years of age 
must have twelve hours in bed even though he 
does not sleep all of this time. Putting him to 
bed at a certain hour each night is the best means 
of developing the regular habit of sleep. 

The child from six to fifteen years must have 
ten hours of sleep. It is not hard to realize what 
sleep can accomplish. The child with proper rest 
will immediately show the results in improved 
nutrition. And this is the only measure needed 
to overcome some cases of malnutrition. The 
child who is backward and dull in school may 



232 MATERNITY AND CHILD CARE 

only need more hours of rest for repairing and 
renewing muscle and nerve tissue. 

The nervous, pale, thin child needs an extra 
hour or two of rest after the mid-day meal. He 
should be put to bed in a darkened well- ventilated 
room. Such a child soon learns to get a two-hour 
sleep which will accomplish wonders in building 
him up. The room in which the children sleep 
should be cool, with the window open. The cov- 
ering, warm but not heavy. They should be put 
to bed between eight and nine each night. This 
allows time, if the heavy meal comes in the even- 
ing, for the stomach to empty itself. The child 
who goes to bed with a loaded stomach is restless 
and suffers from indigestion. Do not allow candy 
eating after the evening meal. 

If the child is restless and does not sleep, find 
the reason. The bowels may not have moved dur- 
ing the day and if not, an enema should be given 
before he goes to sleep. Enlarged tonsils or ade- 
noids may compel mouth breathing, and this will 
make him restless and uncomfortable. The child 
who is restless at night may possibly have worms, 
or have developed bad sleeping habits. This is 
taken up in the final chapter. 

CLOTHING 

One of the most common causes of catarrh, 
colds and bronchitis is the dressing of children 
too warmly indoors and not warmly enough out- 



TEACHING HEALTH 233 

doors. With the temperature of the room at 
70° summer heat, in the winter time when the 
children are dressed in their warm underwear 
and other heavy clothing, the sudden change 
to ourdoor temperature, often fifty degrees 
lower, with little additional clothing, this is 
a very common cause for "catching cold." The 
pulse beat in children is far more rapid than 
that of adults, their blood circulates faster, con- 
sequently they are more easily overheated and 
afterwards chilled. The heavy clothing in the 
warm room causes perspiration and the quick 
change to the cold air, with little more clothing, 
causes rapid chilling of the body, driving the 
blood in, causing congestion of the deeper organs 
and this condition favors cold and catarrh. 

The error is sometimes made of keeping the 
child's winter underwear on in the summer. This 
prevents the skin from getting rid of the body 
heat and unless the heat generated by the food 
is thrown off through the skin, the body tempera- 
ture gets too high, the child becomes nervous, 
restless and irritable and fever may develop. 
Give the child the lightweight but warm wool or 
wool-and-silk or wool-and-cotton underwear with 
long sleeves, during the cold weather, but keep 
heavy sweaters, long warm coats, mittens and 
caps for outdoor wear, and do not let the child 
run out to play in cold weather without sufficient 
additional clothing. 



234 MATERNITY AND CHILD CARE 

Do not allow children to sleep in their heavy 
underwear which has been worn during the day. 
This underwear should be aired at night. The 
warm sleeping garment should be looser, and this 
should be aired during the day. The garments 
worn next the skin are full of perspiration, and 
their regular airing and drying is as important 
as bathing. 

EXERCISE 

Most children get plenty of exercise in their 
outdoor games, walking, running and jumping. 
The child who becomes exhausted and utterly 
fatigued by ordinary exercise must have his heart 
examined by the physician. This is important. 
The heart may be weakened or diseased and the 
strain of hard playing may be so great as to 
permanently damage it. There is always great 
danger of the sickly, nervous child over-exerting 
in his desire not to be outdone by the other chil- 
dren. Under the stress of excitement they easily 
overdo. Guard the recreation of your children 
carefully. Insist upon the two-hour rest in the 
middle of the day for the sickly child. 

Teach children the value of deep breathing 
early. Show them haw to take the breath in 
slowly through the nose and slowly exhale it. 
Children with round shoulders and narrow chests 
must be given special exercises. The dumb-bells, 
Indian clubs and pulley-weights are all splendid. 



TEACHING HEALTH 235 

For those who do not have these advantages 
practically the same benefits may be had from 
the following deep-breathing exercises, given 
before an open window or door morning and 
night. 

Deep-Breathing Exercise. — Stand erect, and to 
stand erect simply raise the chest high centering 
the thought on the chest, when this is done the 
shoulders and abdomen fall naturally into a cor- 
rect position. Now raise the arms straight up, 
palms forward, and extend them in a straight line 
above the head. Next, keeping the knees unbent 
and the arms still extended straight sweep the 
arms slowly downward until they come as near 
touching the floor as can be done with the knees 
unbent. While the arms are swinging slowly 
down gradually breathe out all the air in the 
lungs. Hold this position for two or three sec- 
onds and then slowly raise the extended arms 
forward and up until the body comes into the 
upright position again with the chest high and 
the arms raised straight above the head. While 
swinging the arms slowly up to this position 
breathe in a long deep breath. Hold it; close 
the fists and flex all the muscles in the arms and 
with clenched fists bring the arms down, elbows 
bending out, until the fists rest in front of the 
armpits on either side of the chest and the elbows 
come as near touching at the back as possi- 
ble. While forcibly bringing down the clenched 



236 MATERNITY AND CHILD CARE 

fists, hold the breath which is this way is forced 
to the bottom of the lungs, and when the fists rest 
on the chest exhale all the breath in the luftgs 
slowly, dropping the hands to the side. Then raise 
the hands again to the first position, extend- 
ing straight above the head, palms out and repeat 
the exercise, expelling the air with the downward 
sweep of the hands; inhaling it with the upward 
sweep of the hands and forcing it down in the 
lungs with the downward sweep of the fists to 
the chest, then expelling it. Repeat it three times 
only the first day, and increase by one exercise 
each day until up to twenty times morning and 
night. 

Exercise for Constipated Children. — Lie flat 
on the floor or in bed, with arms outstretched 
over the head in a straight line with the body, 
legs straight. Slowly raise the body, keeping the 
arms outstretched and the legs and heels flat on 
the floor, until the fingers touch the toes. Do 
this five times each morning and increase to ten 
times. If the child has a stubborn tendency to 
constipation let him do this twice a day. 

The Nervous and Forward Child. — The nerv- 
ous child usually has a nervous mother or an 
irritable father. Mothers who are easily upset, 
overanxious and worried over their children, are 
constantly holding up a bad example for the 
small ready imitators. A child likes sympathy 
and soon learns to do things that focus attention 



TEACHING HEALTH ™ 

upon him. A child quickly finds that if he is 
easily disturbed he wins extra attention. This 
becomes the spoiled child and the spoiled child 
becomes the spoiled adult. Many things produce 
nervousness in a child, such as improper hygiene, 
poor food, infected tonsils and teeth, lack of 
fresh air, improper rest and sleep. But there 
are thousands of children in whom these errors 
are not allowed to persist that remain nervous. 
Their care is a matter of discipline. Not the 
constant nagging that keeps forever at the child 
and makes him still more irritable but the calm 
effort to turn the child's thoughts into channels 
of interest away from himself. The nervous 
child burns up energy rapidly and needs less 
exercise, more rest, and everything done to build 
up the general health. The cool sponge of the 
body after the warm bath, the ten minutes swim 
in cool water, the deep-breathing exercises and 
all the other attentions to hygiene, are invalu- 
able. Mothers and teachers must carefully guard 
the precocious child, the abnormally bright mind. 
He must always be held back; not pushed ahead. 
The constant mental exertion far beyond his 
years, in accomplishing difficult feats, such as 
memorizing recitations and musical compositions 
and complicated dancing steps, require too much 
concentration and mental application for the 
undeveloped mind. This is all done at the 
expense of the body and eventually leads to a 



238 MATERNITY AND CHILD CARE 

nervous breakdown. The precocious child should 
spend less time at his books and music and more 
time in outdoor recreations. 

AWARDS OF MERIT 

The mother in her task of teaching health 
should employ some of the measures that have 
proved successful at school and in the business 
world. Children have their own interests and 
do not relish the idea of taking time to do the 
daily little things that bring their own reward 
of good health and happiness. They are too 
young to realize as you do what this will mean 
to their future. Therefore, it is well to establish 
a system of reward for careful attention to these 
details. Give the child who gets his lessons in 
hygiene each day, as you direct them, a good 
mark. Let it be the word of praise spoken in 
the presence of the one the child admires, the 
extra pleasure or play-spell^ a day's fishing, or 
excursion to town, the "movies," a new story- 
book, a little party, something that makes a last- 
ing impression of pleasure. The child should be 
taught the benefits of doing these things without 
additional reward, but it has been proved in all 
teaching that the lessons are more aptly learned 
when there is something pleasurable to look for- 
ward to as a result. 






TEACHING HEALTH 



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CHAPTER XIX 

DIET FOE THE SCHOOL CHILD 

The Diet arranged and endorsed by the Bureau 
of Education, Department of the Interior, U.S.A. 

GOOD FOOD HABITS 

The child is the adult of tomorrow. The kind 
of food a child has today determines to a con- 
siderable extent the fitness of the future citizen. 
Those who direct the feeding of the child have 
a responsibility which cannot be overlooked. 
Good food habits should start today. Tomorrow 
may be too late. 

1. Meals should be given at regular times. — 
There should be regularly appointed hours for 
eating. Do not allow children to eat except at 
these hours unless ordered by a physician. If 
the child gets very hungry two or three hours 
before time for the next meal, give him a slice 
of bread and butter. Do not give a child candy, 
fruit, nuts, cake and cookies between meals. 

2. Plenty of water should be given. — Children 
as well as adults should drink plenty of water 
between meals. Water will of ton satisfy the 
craving which many mistake for hunger. Food 

241 



242 MATERNITY AND CHILD CARE 

should not be washed down with water during 
meals. 

3. Children often have to be taught to like 
things which are good for them. — Be patient, but 
firm, in teaching a child to like new foods. Begin 
by giving a small amount of new food; give but 
one new food at a time, and repeat it regularly 
until the child learns to like it. 

4. Children should not be forced to eat when 
not hungry. — Forced feeding causes more harm 
than light eating for a few days. If the appe- 
tite does not return, consult a physician. 

5. They should be happy while eating. — Let 
the mealtime be a joyous occasion, without undue 
excitement just before, during, or after eating. 

6. Plenty of time should be allowed for meals. 
— Insist on thorough chewing so that the stom- 
ach may not be overtaxed. 

7. Dirt is dangerous. Children should have 
clean hands and faces while eating; they should 
sit down to a clean table and eat in an orderly 
manner. Flies should not be allowed to alight 
on the food either before or during mealtime. 

THE CHILD'S FOOD 

A child should not be allowed to make his 
entire meal from one or two articles; he needs 
a variety of foods to supply all kinds of growing 
material. He can not develop normally unless 
he has this variety. Every day the diet of the 



DIET FOR THE SCHOOL CHILD 243 

cJiild should contain some of each of the following 
types of foods : 

1. Milk. — This is the best and most important 
food for growing children. No other food can 
take its place. Children over five years of age 
should have three to four cups a day. Milk 
should not be given very cold. Warm milk is 
more easily digested. Oftentimes milk can be 
taken warm when it causes distress if taken cold. 
If children rebel against drinking milk alone, it 
may be given in the form of cocoa, milk soups, 
custards, etc. Where is is impossible to get fresh 
milk, dried milk or evaporated milk may be used. 
If dried skimmed milk is given, give the child 
plenty of vegetables and, if possible, some cream 
or butter. Tea and coffee should not be given to 
growing children at all. 

The first food a family should buy is milk. 

The last food to be dispensed with is milk. 

— Dairy Bureau of Massachusetts. 

2. Eggs, Fish, Fowl, Meat, or Their Equiva- 
lents. — Where plenty of milk and an egg a day 
are included in the diet of the child, very little 
meat need be given before the seventh year. 
Allow not more than two ounces of meat daily 
for a child from seven to ten years ; three ounces 
daily from ten to fourteen years. The broth from 
stews may be given on vegetables and bread. 
Where meat and eggs can not be purchased 
because of cost and scarcity, the diet should con- 



244 MATERNITY AND CHILD CARE 

tain a quart of milk, with pea or bean soups, 
spinach and other green vegetables, oatmeal, and 
dried fruits. Vegetables and fruits are also 
excellent sources of iron and other elements nec- 
essary for growth, and, combined with milk, will 
supply food value more than equal to meat. 

3. Bread, Cereals, and Other Grain Products. 
— These should furnish at least one-third of the 
food required by the child. The most nourishing 
ones should be included in the diet; cereals and 
flours with some of the outside of the grain are 
more nourishing than the refined flours. Hence, 
entire wheat flour and brown rice are better than 
white flour and white rice. They also help to 
prevent constipation. 

The following list gives the cereals and flours 
in the order of the amount of nourishment which 
they contain, and their rating, based upon the 
proportion of the chief elements in the food which 
are necessary for growth: 

Oatmeal 2,500 Macaroni 1,350 

Force 2,300 Cream of Wheat 1,350 

Shreaded wheat 2,200 Farina 1,350 

Graham flour 2,200 White wheat flour 1,250 

Barley 1,450 Hominy 1,150 

Rye flour 1,450 Rice (white) 1,150 

Cornmeal 1,350 Corn flakes 1,100 

To reduce this to a cost basis, divide the rating 
given above by the cost per pound and compare 
the food* value with the money spent. Oatmeal 
at eight cents a pound gives 310 food units for 



DIET FOR THE SCHOOL CHILD 245 

every cent spent. Hominy at seven cents a pound 
gives 164 food units for every cent spent. Then, 
oatmeal is much more economical than hominy. 
For older children (over ten years) cereals and 
breads may be varied and the food value 
increased by the addition of dried fruits. 

Dates at twenty-five cents a pound are cheaper 
than fresh apples at five cents a pound and make 
a valuable addition to cooked cereal. (To pre- 
pare dates, wash, chop in small pieces, and stir 
into any cereal.) Stewed prunes may be used 
in the same way. They are especially good with 
hominy and other white cereals. Mixed cereals 
offer a great variety of flavors. Two or three 
kinds may be cooked together. 

Cereals should be thoroughly cooked. If chil- 
dren do not like them, it is usually because they 
have not been properly cooked and served. They 
need long, slow cooking over boiling water or in 
a tireless cooker. The cereal may be cooked the 
night before, and reheated in the morning in a 
double boiler, or by setting the dish in a pan of 
hot water. 

Directions for cooking cereals : Stir the cereal 
into the right amount of boiling salted water, and 
cook over direct heat until the cereal thickens, 
stirring constantly. Then get into boiling- water 
or the fireless cooker and cook as long as directed 
without further stirring; proportions are as fol- 
lows: 1 cup of corn meal, 6 cups water, 1 to 2 



246 MATERNITY AND CHILD CARE 

teaspoonfuls salt and cook 3 hours; 1 cup wheat 
preparations, 4 to 6 cups water, 1 to 2 teaspoon- 
fuls salt and cook 1 hour; 1 cup hominy, 4 cups 
water, 1 teaspoonful salt and cook 3 hours; 1 
cup rolled oats, 2 to 2y 2 cups water, one-half 
teaspoonful salt and cook 2 to 3 hours. 

Uncooked or "dry" cereals may be given occa- 
sionally, if cost can be disregarded, and with 
milk and fruit make an agreeable supper dish. It 
should be remembered that it takes two or three 
times as much of these dry cereals by volume 
to supply the same amount of food as of cooked 
cereal. 

Cereals should be served with milk and not 
more than one teaspoonful of sugar to a saucerful 
of cereal. For those who take them well without 
sugar, it may be omitted altogether. Flours and 
cereals may be made into bread, puddings, soups, 
cookies, etc. 

4. Vegetables. — These are a very essential 
part of the diet. They are especially necessary 
if milk is lacking. There is little danger of eat- 
ing too much of the right kind of vegetables in 
a well-balanced diet. They are very important 
in helping to guard against constipation. Often- 
times hunger is due to the absence of vegetables 
in the meals, and children who crave more food 
find their appetite satisfied where vegetables are 
given regularly. They give volume or bulk to 
the food. Potatoes, baked, boiled or mashed, 



DIET FOR THE SCHOOL CHILD 247 

should be given practically every day. They are 
economical even at five cents a pound. Other 
valuable vegetables are dried and fresh peas and 
beans, spinach, onions, string beans, squash, caul- 
iflower, asparagus, carrots, stewed celery, and for 
older children parsnips, oyster plant, and tur- 
nips; and in summer all kinds of "pot greens" 
such as beet tops, turnip tops, dandelions, chard, 
and cooked lettuce. Dried and canned vegetables 
if of good quality may also be given in winter. 
Almost all vegetables except cabbage, cucumbers, 
and corn may be used freely after the fifth year ; 
corn should not be given before the twelfth year. 
In soups and stews more vegetables and less meat 
should be used than is common practice. Meat 
should be used chiefly for its effect in adding a 
flavoring. 

Much valuable food material dissolves in the 
water in which vegetables are cooked. This 
decreases their value as food. So far as possible, 
this water should be used in making meat gravies 
and soups. Vegetables should be cooked only 
long enough to become tender. 

5. Fruit. — There should be some f rait in the 
diet every day. Where fresh fruit is not possi- 
ble, use dried fruit. Fresh fruit should be given 
only in season; it should be very ripe, but not 
decomposed. Bananas are not ripe until the 
skins have brown spots. If served before this 
stage, they should be baked or boiled. They 



248 MATERNITY AND CHILD CARE 

should not be given raw before the tenth year. 
Jams and preserves should be avoided. 

6. Sweets. — There is great danger of children 
getting too much sugar and spoiling the appetite 
and the digestion. Children should not have, all 
told, more than the following amounts : 

5 to 7 years *. . .1 tablespoonful daily 

7 to 12 years 2 tablespoonf ulk daily 

Sugar is less likely to be harmful when taken 
in cocoa, rice, or other simple puddings, custards, 
or in dried fruits, fresh fruits, and vegetables. 
Molasses has a higher food value than sugar and 
its frequent use should be encouraged. What- 
ever sweets are given should be at the end of a 
meal; never between meals or at the beginning 
of a meal. They spoil the appetite for other nec- 
essary food. 

7. Fat. — This is an essential for growing 
children. Milk fat (cream and butter) is the 
most important kind. Children should, if possi- 
ble, have unskimmed milk. If the cream is 
removed from their milk, they should have plenty 
of butter; or butter substitutes, such as nut but- 
ter or oleomargarine, may be used. Vegetable 
oils may be given to increase the energy of grow- 
ing children; corn, olive, cottonseed, and peanut 
oils are all good. Fat is more easily digested 
uncooked. Children should not have cooked fat 
except bacon. All fried foods should be avoided. 



DIET FOR THE SCHOOL CHILD 249 

PLANNING THE MEALS 

The meals of a school child should be planned 
to give enough variety and provide all the grow- 
ing material needed. The following suggestions 
will help to provide well-balanced meals for 
school children : 

1. Breakfast should contain milk, bread and 
butter, and when possible, in addition, cereal, 
fruit, or egg. 

Milk may be taken partly with a cereal, the 
rest drunk plain or with cocoa. 

Bread should be stale or toasted (whole wheat, 
oatmeal, cornmeal, rye, barley, or white bread 
or any other simple bread). 

Butter may be oleomargarine, nut margarine, 
or some other butter substitute ; it should always 
be given freely if cream has been removed from 
the milk used. 

The best cereals are oatmeal, Wheatena, Petti- 
john, cornmeal, samp, hominy, rice, farina, Cream 
of Wheat. 

Fruit may be orange, stewed or fresh apple, 
ripe pear or peach, thoroughly ripe or cooked 
banana, stewed dried fruit such as dates, figs. 
prunes, apples, or peaches. 

The fresh fruits in season are to be preferred 
where it is possible to obtain them; they are 
usually expensive, however, and one often gets 
much better return for the money in dried fruit. 



250 MATERNITY AND CHILD CARE 

All fruits except orange should be cooked for 
children under seven years old. 

Eggs may be given soft-boiled, poached, scram- 
bled (plain or in milk) and omelette. Fried eggs 
should not be given. 

2. Dinner, or the heaviest meal, should pre- 
ferably be in the middle of the day. This is not 
feasible when the child must hurry home from 
school, eat rapidly and rush back; nor when the 
child must carry his lunch to school; nor when 
the mother can prepare but one dinner a day 
and the father must have his at night. For a 
light midday meal, give a vegetable soup, bread 
and butter, a simple dessert or the meals here- 
after indicated for supper. An ideal dinner 
should consist of soup, meats or eggs, vegetables, 
bread and butter and dessert. 

Clear meat soups or broths have very little 
nourishment. Soups for children should be made 
from dried peas or beans, or with fresh vegeta- 
bles, such as potato, spinach, carrots, peas and 
onions; such soups with the addition of rice or 
barley and a small amount of milk make a very 
nourishing dish. 

Meat should be given but once a day, and the 
quantity should not be large. Lean beef, mutton, 
lamb, chicken, and such fish as cod, haddock, and 
halibut, but not salt or dried fish. As a rule cold 
meat should be avoided by young children 
because it is rarely chewed properly. 



DIET FOR THE SCHOOL CHILD 251 

Vegetables should form a large part of the 
diet especially in summer. A list of those avail- 
able has already been given. Bread and butter 
should always be given. 

With plenty of bread and butter and vegeta- 
bles, dessert is not essential. When given, it 
should always be plain and simple. The most 
wholesome desserts are cereal puddings with 
fruit, such as rice, oatmeal, baked Indian or bread 
pudding, plain cookies, cake and cocoa or fruit 
custards, junkets, ice cream or ices, stewed, dry or 
fresh fruit, sliced orange or sweet chocolate. Sug- 
gested dinner combinations are given in later 
pages. 

3. The supper, when the hearty meal is given 
at midday, should be a simpler meal. Give dishes 
made of milk, eggs, strained vegetables, cereals, 
and fruit, rather than meat, whole vegetables, 
and sweet desserts. 

Some suggestions for supper are as follows: 

Bread and milk, baked potato, stewed fruit. 

Cereal and milk, bread and butter, baked 
banana. 

Poached egg on toast, baked potato, bread and 
butter, apple sauce, and ginger bread. 

4. The child needs at least three good meals 
a day. If he has to carry a luncheon to school, 
it should be a substantial one which will give him 
nourishment enough to keep him from getting 
exhausted during the afternoon. The hot midday 



252 MATERNITY AND CHILD CARE 

meal is to be preferred ; but it is better to carry 
a well-balanced luncheon than to hurry home, 
bolt half the dinner for fear of being late, and 
get exhausted before the end of the day. It is 
desirable to have hot soup or cocoa at school; 
it is then easy to supplement this. If, however, 
he must carry the whole luncheon, it must be 
a nutritious as well as an appetizing one. 

Suggestions for a basket luncheon: The most 
feasible are sandwiches, dessert, fruit, and a bot- 
tle of milk. 

For sandwiches use the most nourishing kinds 
of bread, such as whole wheat, oatmeal, brown, 
raisin, or nut bread. Appetizing fillings may be 
of egg, chopped meat, cheese (American), fresh 
cottage cheese plain or combined with dried 
fruits, sliced tomatoes, chopped vegetables such 
as beets or lettuce, jelly, or peanut butter 
and chopped raisins or dates. Where possible, 
a baked custard adds variety. If fruit is not 
included in the filling, a small glass jar of some 
stewed fruit or apple sauce may be added, some 
fresh ripe fruit, or a few dates. 

For dessert plain cookies, ginger cookies or 
those with cheese, date cookies, sponge cake, 
gingerbread, or sweet chocolate. It is easy to 
get a small jar with a tight screw top for sauce, 
puddings, and custards and to get a bottle for 
carrying milk. 



DIET FOR THE SCHOOL CHILD 



253 



SAMPLE SUMMER DIET FOR A WEEK FOR CHILDREN 
7 TO 12 YEARS 



BREAKFAST 



DINNER 



SUPPER 



Oatmeal, V 2 to % 


Lamb stew, with 


Potato soup, with 


cup, with milk. 


vegetables, small 


milk, 1 cup. 


Stewed fruit, 2 to 3 


portion. 


Poached egg on 


tablespoonfuls. 


Squash or string 1 


toast. 


Bread and butter, 2 


beans, 2 to 3 ta- 


Brown bread and 


to 3 slices. 


blespoonfuls. 


butter, 2 to 3 


Milk to drink, 1 


Bread and butter, 2 


slices. 


glass. 


to 3 slices. 


Stewed prunes, 4 




Bread pudding", 2 


to 5. 




tablespoonfuls. 


Milk to drink, 1 
glass. 


Force or cornflakes, 


Chicken with rice, 


Spinach soup with 


1 cup with milk. 


small portion. 


milk, 1 cup. 


Egg-. 


Mashed potato, 2 to 


Cornbread & syrup, 


Brown bread and 


3 tablespoonfuls. 


2 to 3 pieces. 


butter, 2 to 3 


Dandelion greens or 


Cottage cheese, 1 


slices. 


boiled onions, 2 to 


level tablespoon- 


Milk to drink, 1 


3 tablespoonfuls. 


ful. 


glass. 


Stewed fruit, 2 to 3 
tablespoonfuls. 

Bread and butter, 2 
to 3 slices. 


Ginger cookies, 1. 


Hominy, % to % 


Bacon, 1 slice. 


Cornflakes, 1 to 2 


cup, with milk. 


Poached egg and 


cups, with milk. 


Toast and butter, 2 


spinach. 


Puree of lima beans. 


to 3 slices. 


Spaghetti with to- 


2/3 cup. 


Baked banana, 1. 


matoes, 2 to 3 ta- 


Ginger cookies, 1 


Milk to drink, 1 


blespoonfuls. 


to 2. 


glass. 


Green peas or string 


Milk to drink, 1 




beans, 2 to 3 ta- 


glass. 




blespoonfuls. i 






Bread and butter, 1 






to 2 slices. 




Cornmeal, % to % 


Rice pudding, 1 to 2 


Milk toast or rice, 


cup, with syrup. 


tablespoonfuls. 


x -2 cup with milk. 


Scrambled egg, 1. 


Hamburg steak, 1 


Baked potato, 1. 


Bread and butter, 2 


small ball. 


Bread and butter. 2 


to 3 slices. 


Stewed potatoes, 2 


to 3 slices. 


Milk to drink, 1 


to 3 tablespoon- 


Milk to drink. 1 


glass. 


fuls. 

New beets and beet- 
top greens, 2 to 3 
tablespoonfuls. 

Stewed fruit, 2 to 3 
tablespoonfuls. 

Bread and butter, 2 
to 3 slices. 


glass. 



254 



MATERNITY AND CHILD CARE 



BREAKFAST 



DINNER 



SUPPER 



Shredded wheat, 1 
with milk. 

Cornbread and but- 
ter, 2 pieces. 

Apple sauce or 
stewed pears, 2 to 
3 tablespoonfuls. 

Milk to drink, 1 
glass. 



Pish or clam chow- 
der, % cup, or egg. 

New beets or spin- 
ach, 2 to 3 table- 
spoonfuls. 

Boiled potato. 

Bread and butter, 2 
to 3 slices. 

Custard or junket, 
% cup. 



Oatmeal soup, 1 
cup. 

Squash, chard, or 
carrots, 2 to 3 ta- 
blespoonfuls. 

Stewed fruit, 2 to 4 
tablespoonfuls. 

Bread and butter, 2 
slices. 

Milk to drink, 1 
glass. 

Plain cookies, 1. 



Force or cornflakes, 

1 to 2 cups, with 

milk. 
Poached egg on 

toast. 
Brown bread and 

butter, 2 to 3 

slices. 
Milk to drink, 1 

glass. 



Lamb hash or veal 
cutlet, small por- 
tion. 

String beans, 2 ta- 
blespoonfuls. 

Baked potato. 

Bread and butter, 2 
to 3 slices. 

Apple sauce, 2 to 4 
tablespoonfuls. 



Rice and milk, 2/3 
cup. 

Cornbread and but- 
ter, 2 slices. 

Ginger cookies, 1 
to 2. 

Milk to drink, 1 
glass. 



Rice, % cup with 

milk. 
Bread and butter, 2 

to 3 slices. 
Stewed fruit, 2 to 

3 tablespoonfuls. 
Milk to drink, 1 

glass. 



Dried pea or bean 

soup, 1 cup. 
Baked potato. 
Bread and butter, 2 

to 3 slices. 
Lima beans or new 
beets, 2 table- 
spoonfuls. 
Ice cream or fruit 
sherbet, 2 table- 
-spoonfuls. 



Baked potato, 1. 
Poached egg on 

toast, 1. 
Stewed prunes, 4 

to 5. 
Plain cookies, 1 to 2. 
Milk, 1 glass. 



For the younger children, use more milk and less meat. 



SAMPLE WINTER DIET FOR A WEEK FOR CHILDREN 
7 TO 12 YEARS 



BREAKFAST 



DINNER 



SUPPER 



Oatmeal, 2/3 cup, 


Roast lamb, small 


Scrambled egg, 1. 


with milk. 




slice; baked po- 


Bread and butter, 2 


Bread and butter, 


2 


tatoes. 


to 3 slices. 


to 3 slices. 




Beets, onions, or 


Oatmeal cookies, 1 


Baked apple, 1. 




oyster plant, 2 to 


to 2. 


Milk to drink, 


1 


3 tablespoonfuls. 


Milk to drink, 1 


glass. 




Rice pudding, 2 to 3 
tablespoonfuls. 

Bread and butter, 2 
to 3 slices. 


glass. 



DIET FOR THE SCHOOL CHILD 



255 



BREAKFAST 



DINNER 



SUPPER 



Hominy, 2/3 cup 


Vegetable soup with 


Baked potato, 1. 


with milk. 


carrots, beans, 


Bread and butter, 2 


Bread and butter, 2 


onions, 1 cup. 


to 3 slices. 


to 3 slices. 


Spinach with 


Stewed apricots, 2 


Bacon, 1 slice. 


poached egg, 2 to 


to 3 tablespoon- 


Cocoa with milk, 1 


3 tablespoonfuls. 


fuls. 


cup. 


Cornbread and but- 


Cottage cheese, 1 




ter, 2 to 3 slices. 


tablespoonful. 


i 


Dates, 4 to 5. 




Cornmeal, % to 2/3 


Rice and meat loaf, 


Rice and milk, *£ 


cup, with milk. 


small portion. 


cup. 


Toast and butter, 2 


Stewed celery or 


Baked banana, 1. 


to 3 slices. 


cauliflower, 2 to 3 


Fruit cookies, 1 to 2. 


Apple sauce, 2 to 4 


tablespoonfuls. 


Bread and butter, 3 


tablespoonfuls. 


Bread and butter, 2 


to 4 slices. 


Milk to drink, 1 


to 3 slices. 




glass. 


Baked Indian pud- 
ding-, 2 table- 
spoonfuls. 




Oatmeal, 2/3 cup 


Beef stew with veg- 


Cornbread & syrup, 


with milk. 


etables, small por- 


2 to 3 pieces. 


Bread and butter, 2 


tion. 


Soft egg. 


to 3 slices. 


Bread and butter, 3 


Bread, 2 to 3 slices, 


Stewed prunes or 


to 4 slices. 


and peanut butter 


figs, 3 to 4. 


Rice pudding or 


% tablespoonful. 


Cocoa with milk, 1 


custard, 2 to 3 ta- 


Cocoa with milk, 1 


glass. 


blespoonfuls. 


glass. 


Force or cornflakes, 


Chicken, small 


Milk toast, 2 to 3 


1 to 2 cups, and 


slice; potato soup 


slices. 


milk. 


with milk, 2 to 3 


Cottage cheese, 1 


Bread and butter, 2 


cups. 


tablespoonful. 


to 3 slices. 


Creamed carrots or 


Stewed prunes, 4 


Soft egg and ba- 


onions, 2 to 3 ta- 


to 5. 


con, 1. 


blespoonfuls. 


Cookies; milk to 


Milk to drink, 1 


Ginger bread and 


drink, 1 glass. 


glass. 


thin cream, 1 
small piece. 
Bread and butter, 2 
to 3 slices. 




Pettijohn or malt 


Creamed or fresh 


Spinach or bean 


breakfast food, 


broiled fish, small 


soup. 1 cup. 


2/3 cup with milk. 


portion. 


Baked potato, l. 


Bread and butter, 2 


Baked sweet po- 


Cornbread and but- 


to 3 slices. 


tato, 1. 


ter, 2 pieces. 


Soft egg; milk to 


Bread and butter, 2 


Milk to drink. 1 


drink, 1 glass. 


to 3 slices. 

Baked apple, l. 


glass. 



256 



MATERNITY AND CHILD CARE 



BREAKFAST 



DINNER 



SUPPER 



Cornmeal, 2/3 cup, 

and milk. 
Toast and butter, 2 

to 3 slices. 
Stewed dried 

peaches, 2 to 3 

tablespoonfuls. 
Cocoa with milk, 1 

cup. 



Lamb stew with 
vegetables, small 
portion. 

Boiled potato, 1. 

Bread or rice pud- 
ding-, 2 to 3 table- 
spoonfuls. 

Bread and butter, 2 
to 3 slices. 



Celery soup with 

milk, 1 cup. 
Bread and butter, 2 

to 3 slices. 
Custard or junket, 

% cup. 
Ginger cookies, 1 to 

2; milk to drink, 

1 glass. 



Toward spring 1 , when eggs are abundant, they may be given 
more frequently, replacing some meat and milk. Cottage 
cheese should be made at home or the best grade purchased 
and used only when fresh, 



CHAPTER XX 
THE COMMON ILLS 

Constipation.— Constipation in older children 
is usually the result of failure to form proper 
habits when they were young. An effort should 
be made each day to establish a voluntary move- 
ment of the bowels directly after breakfast. Chil- 
dren quickly become preoccupied with their play 
and often repress a natural desire to evacuate 
the bowels. A certain time should be taken each 
morning with regularity and the child taught to 
remain fifteen or twenty minutes, if necessary, 
until the movement has been accomplished. The 
habit should be firmly established. 

The next common cause of constipation is error 
in diet. During the run-about age, from the sec- 
ond to the fifth year, constipation commonly 
results from drinking too much milk. Twenty- 
four to thirty-two ounces a day are enough. This 
is three or four cups and should be drunk at 
mealtime or taken on cereal or other foods. If 
the cream is too rich, from Jersey or Guernsey 
cows, part, or if necessary, all of it, should be re- 
moved temporarily as constipation is very apt to 
result, and the breath become foul, with hard and 

257 



258 MATERNITY AND CHILD CARE 

light colored stools. From the 2nd to the 5th year 
the following foods should form part of the diet : 
peas, string beans, spinach, asparagus, cauli- 
flower and such cereals as cracked wheat, oat- 
meal, hominy and cornmeal, bran biscuits, oat- 
meal crackers, graham wafers, zwieback, whole 
wheaten bread, stewed rhubarb, stewed or baked 
apples, stewed prunes, custards, cornstarch pud- 
dings, junket — all of which are laxative foods. 
Malted milk is a laxative 'drink. Four or five 
teaspoonfuls of malted milk in eight ounces of 
water can be given with the meal in place of 
plain milk. To be more palatable it can be fla- 
vored with a teaspoonful of cocoa. After the 
second year the child will do better on three 
meals a day at regular mealtimes. This aids 
digestion and gives the stomach proper time to 
rest. 

After the fifth year add to the diet such laxa- 
tive foods as : dates, figs, raw and cooked fruits. 
An apple, orange or little stewed fruit at bed- 
time is a help. Don't allow eating between meals. 
If you do not have the evening meal before six- 
thirty or seven let the child have something regu- 
larly after school, in the shape of a piece of 
bread and butter, glass of milk, apple, cookie or 
cracker. Don't give sweets or candy but some- 
thing light and wholesome. Candy invariably 
disturbs digestion, eaten between meals and 
brings on constipation. The small amount that 



THE COMMON ILLS 259 

should be allowed should be taken with or imme- 
diately after the meal. Four or five glasses of 
water must be drunk between meals during the 
day. 

Where constipation persists, give a tablespoon- 
ful of one of the mineral oils at bedtime. None 
of the oil is absorbed ; it acts as a lubricant, and 
it is not necessary to keep giving large doses as 
in the case of laxatives. Raisins, dates and figs, 
a pound of each, with one-half ounce of senna 
leaves put through the meat-grinder three times 
is a splendid remedy for constipation. This 
should be kept in a glass-covered jar and given 
at bedtime, the dose from a small teaspoonful up, 
given in accordance with the results, is excellent 
for children and adults. 

Diarrhea, — The most frequent cause of diar- 
rhea in children is the eating of overripe or 
under-ripe fruit, or food which has started to 
decompose because left too long on ice, such as 
milk, fish or chicken. Ice cream given to a child 
who has become overheated, will cause diarrhea, 
as will swimming too long or wading in cold 
water. 

Diarrhea is one of the first signs of typhoid 
fever. And the same conditions which produce 
Summer Complaint in babies will bring on diar- 
rhea in older children, harmful bacteria getting 
into the intestines from decomposed food. 

In every case of diarrhea give at once a table- 



260 MATERNITY AND CHILD CARE 

spoonful of castor oil and after the bowels are 
emptied give an enema of warm water to which 
yon have added two teaspoonfuls of bicarbonate 
of soda to each quart. Thoroughly flush out the 
bowels with this to get out all the poison. Give 
skimmed milk to which you have added two tea- 
spoonfuls of lime water to each glass. After the 
bowels are thoroughly emptied give barley water 
or rice water, tapioca or cornstarch pudding. 
Don 't give meat or meat broths until the diarrhea 
has stopped and the temperature returned to 
normal, which is 98° or 99° F. Allow plenty of 
water to drink but it should not be very cold. 
When the diarrhea has disappeared and the tem- 
perature is normal return gradually to the regu- 
lar diet. 

To ease the pain, put a hot flannel over the 
abdomen, wrung out of very hot water, and give 
sips of peppermint water. After the bowels are 
emptied give milk of magnesia, one-half teaspoon- 
ful for the younger children and one teaspoonful 
for older children, two hours after the noon meal, 
for three or four days. This is of great benefit 
in aiding the system to return to normal after 
such an attack. 

Indigestion. — Children who are pale and list- 
less, complaining of headache or discomfort about 
the stomach, are usually overfed, or supplied 
with some article of food which habitually dis- 
agrees with them. Children confined in rooms 



THE COMMON ILLS 261 

deficient in oxygen are prone to have indiges- 
tion, and the nervous child who eats rapidly, 
swallowing half-chewed food, invariably suffers 
from indigestion. The stools often show parti- 
cles of undigested food. 

Children should not come to their meals over- 
tired. They should stop work or play long 
enough to get calmed down before eating and 
should remain quiet for at least half an hour 
afterward. It is a bad practice to keep con- 
stantly correcting children as to their table man- 
ners or other faults at mealtime. Let this be 
done some other time so as not to upset the 
digestion. 

When you start to correct indigestion, begin 
with the errors in hygiene, then look to the food. 
Fried foods cause much indigestion and should 
never be given children. The fact that they do 
form a large part of the diet in many families 
accounts for a tremendous amount of malnutri- 
tion and a long train of ills. 

If you are giving milk too rich in cream, 
remove part of the cream. Allow meat only three 
times a week, and never fried. If the child does 
not chew his food properly, cut it up finely until 
he learns to chew it properly. Don't give meat 
soups the same day you give meat, and skim the 
fat off the broths. 

Eggs are not taken well by some children and 
if indigestion persists remove them to see if they 



262 MATERNITY AND CHILD CARE 

are the possible cause. Soups made from peas 
and beans, and if eggs are not disturbing, cod- 
dled eggs, junkets and custards, buttermilk or 
Dutch cheese, all are very valuable in the diet. 
Omit in cases of indigestion all those foods spe- 
cially referred to as undesirable in the chapter, 
The Formative Years. 

A child taken with a sudden attack of indiges- 
tion may be given one-quarter of a teaspoonful 
of bi-carbonate of soda in a cup of very warm 
water. Or, one or two teaspoonfuls of milk of 
magnesia, with sips of hot peppermint water. 
Put hot cloths over the abdomen and empty the 
bowels. The soda or magnesia and peppermint 
are also a relief for hiccups. 

If the child has eaten something very wrong, 
like green fruit, and become suddenly acutely 
ill, pale, with cold hands and feet, prostration 
and severe pain in the stomach, and this comes 
on shortly after eating, you had better try to 
get it out of the stomach at once. A teaspoonful 
of ipecac given every five or ten minutes until 
the child vomits, or a half teaspoonful of mus- 
tard in a half cup of warm water, will cause 
vomiting. As soon as the stomach is empty give 
castor oil or a large dose of milk of magnesia 
to clean out the bowels. 

Poisoning. — In case of swallowing poison or an 
overdose of medicine, send for the physician at 
once and make the child vomit immediately by 



THE COMMON ILLS 263 

the directions just given. If, on the other hand, 
carbolic acid is swallowed, have the child drink 
at once a half cup of water in which a teaspoon- 
ful of bi-carbonate of soda is dissolved, and then 
pour down the throat as much olive oil or sweet 
oil as you can get down. The oil is to ease the 
burning and if you haven't any kind of oil take 
unsalted lard or butter. If the child is given 
an overdose of laudanum or paragoric, give a 
strong cup of coffee and put the feet in a strong 
mustard bath. Make every effort to keep the 
child from going to sleep. 

Injuries. — Every family should be provided 
with a bottle of tincture of iodine. If the child 
falls down and cuts or scrapes off the skin, wash 
the wound clean from every particle of dirt. Use 
peroxide or boric acid solution in very warm 
water and after thoroughly cleansing, paint the 
wound with tincture of iodine on a little swab of 
clean cotton or gauze. This will smart but it will 
prevent infection which may have gotten in 
through the dirt. Eem ember, lockjaw germs live 
in dirt, as do all the germs of blood poisoning. 
If the wound does get infected and the skin 
around it becomes very red and painful get your 
physician at once. Until he arrives follow these 
directions: Dissolve a tablespoonful of boric 
acid crystals in a quart of water, boil for five 
minutes. Wring out of this perfectly clean pieces 
of gauze or linen as hot as can be borne and lay 



264 MATERNITY AND CHILD CARE 

them on thick over the affected part. Cover with 
a folded towel to keep the application hot and 
change these applications every twenty minutes. 
Don't fail to send for your physician at once. 

For burns from steam, hot water, metal or 
fire, apply at once oil of any kind. If you haven't 
oil use unsalted lard or butter and spread thickly 
over the burned area, then cover this with corn- 
starch or flour to keep out the air. As soon as 
possible get equal parts of linseed oil and lime 
water, shake well and pour all over the burned 
part. Cover well with gauze or soft clean linen 
and outside of this put oiled silk or rubber tis- 
sue, which you can procure at the druggist's, to 
keep the burned parts protected from the air. 
Bandage loosely. Change this dressing each day. 
Blisters will form and a needle, sterilized by 
holding over a flame, must be used to prick these 
open to allow the water to escape, i 

Boils. — Boils are more frequent in the delicate, 
poorly nourished infant and child than in fat, 
healthy children. They appear on any part of 
the body, head and scalp. They have to be 
opened and the infection allowed to escape. If 
a boil is not opened but allowed to develop until 
it breaks, the system steadily absorbs the poison 
from the infection and pus. When the boil is 
opened, and this must be done by the physician, 
and the infection is drained out, the whole prob- 
lem is to prevent this pus from getting on the 



THE COMMON ILLS 265 

skin where it will produce other boils. Linen or 
gauze packs, wrung out of hot boric acid solu- 
tion, already described in this chapter, applied 
after the boil has been opened, helps the infection 
to drain out. For children, fifteen grains of boric 
acid thoroughly mixed in an ounce of sterile 
vaseline and covered over the region surround- 
ing the boil for quite a large area, will prevent 
the infection from spreading and other boils from 
developing. 

Children who are subject to boils derive great 
benefit from yeast. A child of three can take one- 
sixth of a compressed yeast cake stirred in a lit- 
tle warm water or milk sweetened with sugar, 
a half hour before eating, three times a day. 
After the third year one-quarter of a cake, and 
grown children and adults a full cake. This con- 
tinued for several weeks will in many cases 
give permanent relief. 

Common Rashes. — Rashes on the skin may be 
from internal or external causes. When a rash 
appears the temperature should be taken and if 
there is fever the doctor should be notified, as 
it may be the beginning of a contagious disease. 
Contagious diseases and the more serious forms 
of rashes are discussed in the volume Diseases 
of Infancy and Childhood. 

Insect bites cause great irritation at times and 
there is danger of poisoning by scratching dirt 
into the bite. A teaspoonful of bi-carbonate of 



266 MATERNITY AND CHILD CARE 

soda dissolved in a glass of warm water patted 
on the spots with a soft, clean cloth, which can 
also be saturated and laid over the bites, is very 
soothing. One-quarter to one-half teaspoonful of 
cream of tartar in a glass of lemonade is a cool- 
ing drink for the blood when the skin is thus 
irritated. 

Ivy Poisoning. — This develops in a few hours 
after the skin has come in contact with the plant. 
The skin swells, reddens and is hot to the touch. 
Tiny blisters form. The swelling is sometimes 
so great that the eyes are closed. Use a wet 
dressing of fluid extract of Grindelia Eobusta, 
which you can procure from your druggist. Put 
one teaspoonful in a pint of water and apply 
with a soft piece of old linen. Another good 
way to relieve the itching is to give a tub bath 
of very warm water, into which you have put 
one-half pound of crude sulphur. Give this twice 
daily. When the acute inflammation has passed, 
annoint the parts with a solution of five per cent 
boric acid in rosewater ointment. 

Hives. — Hives are caused by the irritating 
effect of some food which produces indigestion. 
This subject is discussed in detail in Volume III. 
As soon as hives appear watch for some food 
that is causing the trouble, such as oatmeal, eggs, 
strawberries, tomatoes or buckwheat and elimi- 
nate it from the diet. Give several doses of milk 
of magnesia, or rhubarb and soda, which you 



THE COMMON ILLS 267 

can easily procure. Cut down the diet to broth 
and gruels, omitting milk. Make a solution of 
one teaspoonful of baking soda in a glass of 
warm water and lay pieces of cloth wrung out 
of this on the itching parts. 

Ring-worm. — This appears on any part of the 
body in round slightly raised areas covered with 
gray-white scales and the hair which grows on 
the skin becomes broken off. This infection 
spreads readily. It can be acquired from other 
people, by using their towels, and also from cats 
and dogs. If on the scalp, the hair must 
be clipped ; the scalp or other, parts well washed 
with tincture of green soap, then thoroughly 
rinsed and the areas painted, covering well over 
the edge with tincture of iodine. In tw r o or three 
days the spots must again be painted and this 
treatment repeated until they dry up and 
disappear. 

Frost-bite. — If the hands or feet are frost- 
bitten keep them away from the fire. Put them 
in very cold water constantly rubbing them. As 
soon as the circulation returns gradually add 
warm water. Serious frost-bites should always 
receive your physician's attention. If the skin 
peels off and is sensitive put on a little zinc 
oxide ointment and protect it with a piece of 
gauze. 

Itch. — This usually begins between the fingers 
and toes. It is caused by a parasite that bur- 



268 MATERNITY AND CHILD CARE 

rows under the skin. It is often acquired at 
school. By scratching it is quickly spread to 
other parts. Apply a sulphur ointment which 
your druggist can supply, cover thickly and 
bandage. Don't allow anyone 'else to use the 
towels, and keep up the treatment for a week. 
Then take a hot bath, scrubbing the body well 
with tincture of green soap. 

Lice. — These are sometimes acquired at school 
and can be gotten rid of by clipping the hair 
short and saturating the scalp and hair with kero- 
sene, leaving it on overnight and tying something 
around the head. Thoroughly shampoo in the 
morning with soap and water. Instead of kero- 
sene, tincture of larkspur can be used, or strong 
vinegar. Eepeat the treatment every second day, 
combing the hair with a fine tooth comb, until 
the trouble has disappeared. If the hair is not 
cut short a longer time is required to get rid of 
the nits, which the lice cement to the hair. 

Earache. — Earache always demands your phys- 
ician ? s attention as an infection may have got- 
ten into the middle ear and there may be pus 
behind the drum membrane. An infection is 
often pushed up through the eustachian tube into 
the middle ear by holding both nostrils closed 
when blowing the nose. Teach your child to blow 
the nose by compressing one nostril at a time and 
gently blowing through the other. Enlarged ade- 
noids and infected tonsils are aften followed by 



THE COMMON ILLS 269 

diseased middle ear. Irrigate the ear with very 
warm water in the fountain syringe as described 
later or use an ear syringe. A five per cent solu- 
tion of carbolic acid in an ounce of glycerine, two 
or three drops being put into the ear, keeping the 
drops in by lying on the other side and putting 
in a wad of cotton, will oftentimes check an 
inflammation of the middle ear in the beginning. 

If any foreign substance gets into the ear such 
as a bug or bean, or if hard chunks of wax form, 
the first thing to do is to pour in a little warm 
sweet oil, letting it remain to soften the obstruc- 
tion, and then lie on that side of the head to try 
to induce it to come out. If this fails take the 
child to the doctor. If this is impossible, fill the 
fountain syringe with warm water. Boil the tip 
before using, and raising the syringe two and a 
half or three feet above the child's head, irri- 
gate the ear by letting the water run in and out, 
the head being held sidewise over a basin. Never 
stick anything into the ear such as a hairpin or 
toothpick. . 

Eyes. — When the eyes become inflammed or 
reddened they should be washed out with a solu- 
tion of boric acid made in the way I have al- 
ready instructed and used warm, dropped in 
with an eye-dropper which you first thoroughly 
rinse in boiling water, or squeezed in with per- 
fectly clean hands and a sw r ab of sterile cotton. 
holding the lids gently open. Two or three drops 



270 MATERNITY AND CHILD CARE 

of a fifteen per cent solution of argyrol instilled 
in both eyes twice daily will usually give prompt 
relief from ordinary infection. 

Cinders, dirt or fine pieces of steel get into 
the eyes and should be removed at once as these 
may set up a violent inflammation or may scratch 
the cornea, ulcers developing, impairing, and in 
many cases causing complete loss of eyesight. 
Wash the hands thoroughly, roll the upper lid 
back over the finger or a pencil and you will 
generally find the foreign particle imbedded be- 
neath the upper lid. This can easily be picked 
off with a little piece of cotton wound around a 
toothpick. Wash all particles of dirt out of the 
eye with a boric acid solution. If you have argy- 
rol put a drop or two into the eye to prevent any 
possibility of infection. Because argyrol is very 
dark and stains for a moment or two do not think 
that it injures the eye. 

The cross-eyed child should be put in the hands 
of the best occulist that can be secured, and the 
eyes straightened by means of glasses, or an 
operation, if necessary. This should be done in 
the child's second or third year and it is some- 
times done even earlier. 

The near-sighted child should be properly fitted 
with glasses. Near-sightedness is early detected 
as the child will hold objects abnormally close to 
the eyes to see them and will complain of head- 
aches. 



THE COMMON ILLS 271 

Sties are common and come on both lids. To 
remove them soak a piece of sterile gauze or per- 
fectly clean kandkerchief in warm lead-water 
and lay over the lids covering this over with a 
piece of oiled silk or soft folded cloth and bind 
with a handkerchief. Put the warm solution 
on two or three times during the day. If they 
develop until you can see pus in them, sterilize 
a needle by holding it over a flame, and open 
them. Granulated lids demand your physician's 
attention. 

BED- WETTING 

This annoying condition is fortunately soon 
out-grown. Children who are mal-nourished, 
have enlarged tonsils or adenoids, indigestion, 
or are nervous, are bed-wetters. 

First give attention to every detail of the gen- 
eral health, regulate the diet, have no eating be- 
tween meals, forbid candy and allow only a 
small amount of sugar with the meals and in the 
food. The supper should be light with the hearty 
meal at mid-day. Give no milk or water after 
four o'clock. If the child is thirsty after that 
time simply allow sips of water which can be 
spat out as soon as the mouth and tongue are 
moistened. Study the diet list in this book for 
the child from the first to the sixth year, learn- 
ing what foods to avoid. At ten or the last 
thing before you retire, take the child to urinate, 
even if sleeping, thus establishing the habit of 



272 MATERNITY AND CHILD CARE 

emptying the bladder at a definite time. He will 
then usually sleep through the rest of the night. 
Tonics may be necessary such as small doses of 
Nux Vomica which should only be used on your 
doctor's advice. 

In boys circumcision may be necessary to stop 
this habit which may be due to the irritation of 
a long adherent foreskin. 

THUMB-SUCKING 

Thumb-sucking deforms the mouth and causes 
the teeth to come in crooked. The hand must be 
taken from the mouth each time this is done, 
beginning as soon as the habit starts in your 
baby. A cot of linen fitted over the thumb or 
finger and tied on will usually break the habit. 
In older children paint tincture of aloes or myrrh 
over the finger ends, as this being bitter will 
stop both thumb-sucking and nail-biting. 

Worms. — Pin-worms, round-worms and tape- 
worms are the three types children are subject 
to. Pin-worms are more common, round-worms 
rare and tape-worms found only occasionally and 
mostly in older children. The signs are nerv- 
ousness, grinding of the teeth, restless sleeping, 
tossing about, complaints of itching around the 
rectum, picking at the nose and bed-clothes, and 
at times, severe cases have been known to cause 
convulsions. In young girls they crawl forward 
in the vagina producing leucorrhoea, an irrita- 



THE COMMON ILLS 27S 

tion which often leads to bad habits. They look 
like small broken pieces of white or yellowish 
thread. The treatment is a large dose of castor 
oil at bedtime, watching the stools next morning 
for signs of them. The treatment must be per- 
sisted in as they are difficult at times to get rid 
of. Give an enema at bedtime, washing out the 
bowels, then lay the child on the side and pour 
six ounces of the Infusion of Quassia into the 
bowel by attaching to the syringe the No. 18 
American catheter, inserted for five or six inches. 
Have the child remain lying on its side to retain 
the solution as long as possible, preferably all 
night. A teaspoonful of table salt in four ounces 
of warm water is used in the same way with some 
success but the Infusion of Quassia is surer. 
Give the child each morning before breakfast 
from one-half to one teaspoonful of rhubarb and 
soda, the dose depending on the age, or give 
compound licorice powder, one-quarter to one- 
half teaspoonful in warm water. 

Bound worms are larger, longer and reddish 
like a small earth-worm. The symptoms are 
much the same as described above. Give a dose 
of castor oil and if they are discovered in the 
stool, clean out the bowels the following night 
with another dose of oil, and in the morning, an 
hour and a half before giving any food give one 
to two grains of Santonin, depending on the age. 
This is given in a little powder with sugar of 



274 MATERNITY AND CHILD CARE 

milk. Eepeat the dose on the second day omit- 
ting the oil at night, omit both for three days and 
again give the oil and repeat the same treat- 
ment for two days. This usually eradicates them 
entirely. Oil of Chenopodium, three or four 
drops on a lump of sugar, repeated twice a day, 
for a child after the fifth year, for three days, 
followed by a dose of castor oil is another meas- 
ure for getting rid of round- worms. 

Tape-worms are of three varieties, coming 
from pork, beef and fish, and vary in length 
from ten to fifty feet. The body is made up of 
flattish, regular segments, white in color. When 
passed in the stool they look like little pieces of 
tape. The symptoms are restlessness, considerable 
colic and a foul breath with an abnormal appetite 
but a thin, poorly-nourished body. The difficulty is 
to dislodge the head. Until this is removed the 
worm keeps growing. The beef tape-worm, which 
is most common, has a square head showing four 
suckers and no hooks. Raw beef may contain 
the eggs. The pork tape-warm, rarely found in 
children, has a head with four suckers surround- 
ing which is a circle of twenty-six hooks. The 
fish tape-worm, which is rare, has an oval head 
with two grooves on the side. The treatment is 
a big dose of castor oil at bedtime and the next 
morning two hours before breakfast a half tea- 
spoonful of Oleoresin of Male-fern, which your 
druggist will prepare for you in an emulsion. Be 



THE COMMON ILLS 275 

sure that the Male-fern is fresh, and the next 
day keep the child on a very light diet of broth 
and gruel. When the worm is passed, carefully 
examine to see if the head has been passed. This 
can best be done with a magnifying glass. If 
the head is not present the treatment should be 
repeated in three or four days. 

BAD HABITS 

In young children bad habits start as a result 
of some local irritation; the cause is a physical 
one, and not as many mothers fear, a mental or 
moral one. In boys the irritation usually comes 
from a tight, adhered foreskin, underneath which 
annoying secretions accumulate. The opening 
through the foreskin may be only of pinpoint size 
and in addition to its causing bad habits, it may 
result in nervousness, sleeplessness and bed-wet- 
ting. In girls, the local irritation is usually from 
pinworms which have crawled forward into the 
vagina setting up a leucorrhoea. In young girls 
leucorrhoea often follows an attack of measles or 
scarlet fever or diphtheria, anything which causes 
the system to become run down. At times it 
is due to a more serious infection, picked up 
from unclean toilets or sleeping with an adult 
who has leucorrhoea. 

The habit of masturbation in young babies is 
usually accomplished by rubbing the limbs to- 
gether or with the hands, and causes the face to 



276 MATERNITY AND CHILD CARE 

redden. In older children it causes paleness, shy- 
ness, listlessness, poor appetite and the child be- 
comes dull in school, avoiding people, always 
seeking seclusion. To correct the trouble in girls 
and girl babies you must first remove the local 
irritation. Look for pin-worms and if present 
see that they are removed at once. If leucor- 
rhoea is the cause begin local treatment starting 
with the sitz bath, in which you dissolve a half 
teaspoonful of powdered alum in one gallon of 
warm water in a clean bowl and let the child sit 
in this twice a day for twenty minutes. Then 
gently dry the parts, not by rubbing but patting, 
applying k very little borated talcum powder, 
dusting it on externally. The discharge may be 
more severe and persistent and if possible should 
be examined by your physician under the micro- 
scope. 

To cure persistent leucorrhoea, get a female 
glass catheter, which you can keep sterilized by 
boiling. Make up each time a quart of fresh 
boric acid solution, a teaspoonful of the crystals 
to each pint of water, boil five minutes, cool to 
the body temperature. Place the child on the 
back in the tub or over a douche pan, the glass, 
catheter gently inserted and a douche of the com- 
plete quart given, at least twice a day to be of 
any value. At times it is necessary to have your 
druggist furnish you with the Permanganate of 
Potash crystals. Tell him to weigh out in each 



THE COMMON ILLS 277 

powder sufficient to make a one to five thousand 
solution when dissolved in a quart of water. Use 
this as a douche twice a day until this more 
serious type of leucorrhoea disappears. Tonics 
and cod-liver oil should be given to build up the 
general health of the child. 

Have the baby wear a thick diaper and over 
this fold a soft, bulky towel, which keeps the 
limbs apart and prevents the baby from rubbing 
them together. If the douche is not used the 
parts must be bathed twice a day gently with the 
boric acid solution. Every effort must be made 
to keep the child's hand away because of the 
danger of infecting the eyes and causing blind- 
ness. The child must sleep alone. At night the 
hands should be constrained by fastening a tape 
around the wrists and letting it pass around the 
neck, fastened about the neck to the nightdress 
by sewing or a safety pin, short enough so that 
the hands cannot reach below the waist. Boy 
babies should be kept clean about the genitals, 
the foreskin freed so that all secretion can be 
removed beneath it, and if this is impossible a 
circumcision is necessary. Use the bulky diaper 
and restrain the hands at night. 

With older children their future health and 
welfare should be safe-guarded by the parents 
who should take the children into their confidence 
and inform them of the true facts of the result of 
this habit. They should know that a boy be- 



278 MATERNITY AND CHILD CARE 

comes dull, backward, thin, pale, a mental and 
physical weakling, easily detected in his habit 
by all who are familiar with its signs. Every boy 
desires strength of body and mind and should 
know that this practice persisted in, in thousands 
of cases results in insanity. And in the case of 
girls it commonly renders them barren, and pro- 
duces physical and nervous breakdown in time. 
Older children in whom the habit is suspected 
should have very little meat, nothing containing 
alcohol, cool shower baths at bedtime, sponging 
with cool water over the spine, no hot or heavy 
underclothes or bed-clothes, a firm, hard mat- 
tress, and should be encouraged to sleep on side 
or face. They should have healthy, outdoor ex- 
ercise, should be made companions of by their 
parents and teachers, and with helpful instruc- 
tion to turn their minds upon interesting things 
to learn and do ; will soon overcome this habit. 



INDEX 



Abdomen, streaks on, 68 

pain in, 260, 262 

baby's, 195 
Abdominal binder, 122, 134 
Abortion (see miscarriage ) 
Abscess of breast, 79 

of roots of teeth, 76 
Accidents to new-born, 160 

as cause of premature birth, 
88 
Acidosis, acid-state in preg- 
nancy, 58 

diet in, 58 

in mouth, corroding teeth, 76 
Adenoids, 232 

infecting ear, 268 
Advice (see physician) 

promiscuous, 71 
After -birth (see placenta) 
After-pains, 125 
Air, fresh, baby's, 172 

children's need of, 227 

in pregnancy, 54 

for sickly children, 229 
Albumin in urine, 55 
Alcohol to harden nipples, 79 
Alcoholism causing defectives, 

90 
Alkalies to counteract acidity, 58 
Amnion, 22 
Amniotic fluid, 22, 113 
Amusements during pregnancy, 

74 
Anatomy of reproductive or- 
gans, 11 
Anger, influencing morning sick- 
ness, 52 
Anemia as cause of irregular 
menstruation, 33 

from infected teeth, 224 
Anesthetic (see chloroform) 
Antidotes for poison, 262 
Appetite, loss of in child, 208 

in pregnancy, 42 

fever in children, 130 
Applications for pain in abdo- 
men, 260 
Artificial feeding, 156 

formulas for, 157 

when not to start, 152 

(see also Milk) 
Asphlxiated baby, 124 



Automobiling in pregnancy, 74 
Awards of merit, 238 

Baby, accidents at birth, 160 

airing, 182 

appearance of new-born, 188 

bathing, 173; bottle, 159; 
bowels, 180 

care of new-born, 122, 143-145 

chafing, 175 

clothing, 104-108, 175, 176 

dressing, 147 

colic, 159 

cord, dressing, 146 

crying, 120, 181, 182 

diet after first year, 200 ; dia- 
rrhea, 259 

ears, 177 

exercise, 182 

eyes, 143, 169, 176 

feeding, artificial, 156 

feeding, breast, 151-154 

genitals, 179 

growth, 186, 187 

habits, 143, 180, 198, 272 

hair, 174, 190 

head, 188, 189, 198 

health, 172, 186, 143 

hearing, 190 

indigestion, 159 

infection, eyes, 143, 168, 176 

mouth, 176, 272 

nails, 174 

navel, 162 

nervous system, 180, 197, 198 

nursing, 151-156 

premature, 86-88 

pulse, 150 

rash, 265 

rest and sleep, 147. 181 

resuscitation at birth, 122 

rupture, 164 

sweat, 193 

senses, 190-194 

skin, 148, 175. 179, 193 

soft spot, 189 

teeth. 17S. 199 

temperature. 150 

thumb-sucking, 272 

tovs. 175 

urine. ISO. 19S. 149 

walking, 197 



279 



280 



INDEX 



Baby (continued) 

water, 151, 159 

weight, 148, 187 

(see also artificial feeding, 
breast-feeding, diet, milk, 
navel, nursing) 
Baby scales, 154 
Backache, from muscles, 17 

from shoes, 69 

strain from uterus, 67 

symptoms of miscarriage, 85 
Bacteria, in intestines, 230 

from decomposing rood, aw 
Bad habits, 275 _ 

restlessness, a sign of, ^ 
"Bag of Waters," 113, 114 

Ba t n o d 'hold y ' S io 1 r d 5 and prevent 
chilling, 146 

pinning, 147 , 19 , 

Bath, after confinement, 133 

baby's, 144, 173 

children's, 220-221 

in pregnancy, 54 67 
Bearing-down in labor 120 

symptom of miscarriage, 85 
Bed, for confinement, 102, iu* 

IffifMU. after con- 
finement, 122 

Birth of baby, 109 
care following, 120 
(see also confinement) 

Birth-marks, 89, 94 

Bites, insects, 265 

Bladder, care after labor, 135 
emptying after confinement, 

135 * an 

infection of, 67 

pressure upon from uterus, 3b, 

109 
teaching control of, 198 (see 

also urine) . 

Bleeding, during pregnancy, 34, 

40, 85 - -,«o 117 • 

following labor, 128, H< , 

from navel, 144 
in child-bed fever, 130 
in miscarriage, 84, 86 
in new-born, 167 
Blindness, 176 . . 

Blood, disease of, causing mis- 
carriage, 83 
disease of, causing sterility, 91 
mother's separated from 

baby's, 25 
transfusion of, 168 
serum, 169 _., 

Body, care of in pregnancy, 71- 

81 
Boils, 264 / «.. fl „i«i 

Bottle - feeding ( see artificial 
feeding) 



Bowels, care of in morning sick- 
ness, 52 
special care of, in pregnancy, 

62-64 

care of, after confinement, 135 

movement of, in new-born, 148 

teaching control of, 180, 198, 

230 

Boys, height and weight of, 187, 

239-240 
Breasts, changes and sensa- 
tions in, during pregnancy, 
34 
care after childbirth, 136 ; 

coming of milk in, 137 
"caked," 137 
, "drying-up," 138 ; expressing 
milk from, 138 
cracks and fisures, 137 
care of, in pregnancy, 79, 80 ; 

massage of, 138 
milk in, after weaning not a 

sign of pregnancy, 35 
immediate weaning, 138 
Breast-feeding, 152-156 
prolonged, 142 

to prevent sore nipples in, 79 
to contract uterus, 151 
first days of, 151 
painful, 137 
Breast-pump, 138 
Breast-binder, 138 
Breathing, after childbirth, 126 
exercises for, 235 
exercises for constipation, 236 
failure, in new-born, 120, 122, 

124 
irregular, in baby, 149 
Breech presentation at birth, 122 
Bulgarian tablets for gas disten- 
sion, 76 
Burns, 264 
Buttermilk for gas distension, 

76 
Buttocks, sore, 175 

Cathartics, 64, 135, 159, 259, 

135, 159 
Cells, male and female, 18 
Cell division in embryo, 18 
Cereals, value as food, 244 
Cereal water, time to use, 159 
Change of life, 13,, 33 
Chest, new-born baby's, 195 

measurements in children, 188 
Child, pre-school age, care of, 
205 

school age, care of, 218 
Chill after childbirth, 125, 129 
Child-bed fever, 129 
Childbirth (see confinement) 
Chloroform during labor, 114 

in repairing tears, 116 



INDEX 



281 



Chorionic membrane, 22 
Circulation of blood through 

placenta, 22 
Circumcision, 180 

for bed-wetting, 272 

for bad habits, 277 
Cleanliness after confinement, 
127, 132, 134 

before confinement, 95, 97 

in handling- food, 224 

for cuts and wounds, 263 
Clothing, baby's, 104-108, 175, 
176 

corsets, 69 

children's, for nightwear, 234 

for hospital use, 111 

suspended from shoulders in 
pregnancy, 68 
Clots, in childbirth, 125 

in menstruation, 17 
Colic, labor pains mistaken for 
109 

from sucking air, 159 
Colostrum, 35, 151 
Coffee drinking in pregnancy, 45 

after confinement, 139 
Conception, 37 
/Confinement, 109 

articles needed, 97-103 

in absence of doctor, 119 

care after, 125-142 

diet after, 126 

date of, 37 

hospital supplies, 111 

preparing for, 95-108 

room for, 102 

time to get up, after, 94, 133 
Consanguinity, 91 
Constipation in children, 257 

dangers in pregnancy (see 
bowels) 

gas and flatulence, 75 

exercise for, 236 
Convulsions (see eclampsia) 
Cord (see navel) 
Corsets during pregnancy, 69 

night belt, 70 
Cradle-cap, 190 
Cramps in menstruation, 17 
Cravings of pregnancy, 47 
Creeping, 185 
Crying at birth, 120 

not harmful, 181 

as exercise, 182 
Curettage, 129 
Cutting teeth, 199 
Cuts in children, 263 
Cystitis, pus in urine, 67 

after childbirth, 136 

Dandruff, 222 
Date of confinement, 37 
Decay of teeth, causes of, 224 
in pregnancy, 76-77 



Delayed dentition, 199 
Delivery, premature, 38 
without medical help, 119 
(see also confinement) 
Despondency in pregnancy, 92, 

93 
Desquamation, shedding of skin. 

148 
Development of baby, 186 
Defectives, 90 
Dental floss, value of, 225 
Dentition (see teeth) 
Diapers, 105 

when buttocks are sore, 175 
Diarrhea, 259-260 
Diet, child's, first year, 200 
second year, 200-201 
third year, 201-202 
school years, 241-256 
laxative, 257-259 
suggestions for young child's, 
213 
Diet, general, foods to avoid, 
204 
regulating wrong, 209-211 
sample of for summer, 253 
sample of for winter, 254 
Diet, mother's in pregnancy, 42- 
49 
in nausea, 51 

influence on size of baby, 28, 48 
last months of pregnancy, 48 
laxative in pregnancy, 45, 62 
after childbirth, 138-139 
influence on breast-milk, 155 
Disease caused by decayed 
teeth, 224 
caused by impure air, 228 
resistance to, in child, 206 
common ills, 257 
prevention of, through proper 

diet, 42, 241 
prevention of, through hy- 
giene, 71, 172, 205, 218 
Discharge, in pregnancy, 110 
(see also infection, leucor- 
rhea and vaginal) 
Discipline, 238, 261 
Displacement (see womb) 
Douche in pregnancy, 80 
after childbirth. 12$ 
in child-bed fever. 130 
Drugs, caution in use of. 212 
Dry birth, 113 
Earache in baby. 177 

in children, 26 8 
Ears, in now -born, 190. 191 
irritating, 269 
something in. 269 
Eclampsia, 56 
Ectopic pregnancy, 40 
Eggs, as food. 243 
disagreeing, 261 
Elastic stocking, 78 



282 



INDEX 



Embryo, growth and food, 21-31 

mother's influence on, 89 
Emetics, after swallowing poi- 
sons, 262 
Endometritis, 82 
Enema, in pregnancy, 59 
Epilepsy, 90, 224 
Ergot, after childbirth, 117, 126 
Eruptions, 265 

Excretory organs, work of, 26 
Examinations (see physician) 
Exercise, affecting breast-milk, 
155 

baby's first, 182 

baby's size affected by, 28 

deeo-breathing, 235 

children's, 234 

in pregnancy, 54, 72, 83 

strengthening abdomen after 
childbirth, 134 

"knee-chest" position, 141 
Eyes, in new-born, 143, 169, 176 

baby's conscious use of, 191 

color, 190 

children's, care of, 269 

cinders in, 270 

crossing, 270 

granulated lids, 271 

near-si erhted, 270 

sties, 271 

Face, puffiness from toxemias, 

54, 58 
Fallopian tube, pregnancy in, 39 
Ealse labor pains, 110 
Fat, value in diet, 248 
Fatigue, guard against in preg- 
nancy, 73 
Fear (see worry) 
Feeding (see artificial feeding, 

nursing and diet) 
Feet, new-born baby's, 196 

swelling in pregnancy, 54, 78 
Fertilization of ovum, 12 
Fetus, growth and position, 18, 
21 
blood of, separated from 
mother's, 25 
Fever, baby, 151 

child-bed or puerperal, 129 
in children, 207 
Flannel binder for varicose 

veins, 78 
Flatulence, 75 

Flies as disease carriers, 184 
Fontanels, closing of, 189 
Food, embryo's, 21-31 

elements needed in pregnancy, 

42-45 
extra, in pregnancy, 44 
(see also artificial feeding, 
nursing and diet) 
Food poisoning, treatment, 262 
from waste in bowels, 230 



Forceps, 118 
Foreskin, 179-180 
Forwardness in child, 207 
Fountain syringe, 80, 128, 236 
Fright (see shock) 
Freezing, 267 
Frostbite, 267 

Fruit, laxative value in preg- 
nancy, 63, 64 
value in diet, 247 
Fresh air (see air) 

Gain in weight, babys, 155 
Gas (see indigestion) 
Genital organs, care in new- 
born, 179 _ 
Genitals, abrasions and cleans- 
ing after labor, 131 
Gestation (see pregnancy) 
Girls', height and weight, 240 

baby girls, 187 
Glands, lymphatic in neck, 225 

sweat, in pregnancy, 49, 54 

sweat, in baby, 193 

(see also breasts) 
Gloves, surgeon's rubber, 96 
Goitre in pregnancy, 88 
Granulated lids, 271 
Grinding teeth (see worms) 
Growth, baby's, 186, 187 

embryo's, 21 

children's, tables of, 239-240 
Gums, infected, 223 

swollen, baby's, 200 
Gymnastics (see exercises) 

Hair, baby's, 174, 190 

child's, 232 
Head, new-born baby's, 189 ; 

holding up, 198 

size, 188 
Headache, 266 
Headlice, 268 

Health, teaching to children, 
218-238 ; baby's, 172, 186 

in pregnancy, 42, 50, 62, 71, 
89 

after childbirth, 125 
Hearing, baby's, 190 

(see also ears) 
Heart-beat, fetal, 28, 37 

baby's during labor, 118 

in new-born, 150 

mother's after delivery, 126 
Heartburn, 75 

Heart-disease, congenital in 
baby, 148 

from infected teeth, 224 

cause of prematurity, 88 
Heat, application to breasts for 

expressing milk, 138 
Height, 187, 239-240 
Hemorrhage, after child - bed 
fever, 130 



INDEX 



283 



after labor, 117 

in miscarriage, 84, 86 

in new-born, 167 

in pregnancy, 40 
Hemorrhoids, 79, 81 
Heredity, 26, 30, 83, 88, 91 
Hernia, 164 
Hives, 266 

Hospital care, 93, 94, 111 
Holding baby (see illustration) 
Hygiene, baby's, 143, 172 

child's, 205, 218 

errors in, 261 

in pregnancy, 53, 71-81 

Ice-cream, danger from, 259 
Icterus (see jaundice) 
Impregnation, 17, 89 
Impressions, maternal, 89 
Indigestion in baby, 159 

children, 260-262 

from fried foods, 261 

in pregnancy, 75 

(see also diet) 
Infant (see baby) 
Infection, baby's eyes, 143, 168, 
176 

breasts, 79 

boils, 264 

childbed fever, 129 

child's eyes, 269, 270 

child's eyelids, 271 

confinement, 95-97, 112, 118 

cord, 162 

decayed teeth, 224, 225 

diseased tonsils, 225 

ears, 268 

navel, 162 

urine, 67 

vaginal, 80, 81, 110, 128 
Inflammation, causing sterility, 
19 

causing miscarriage, 82 

(see also infection) 
Injections in acid-state, 59 

(see also enema) 
Injuries, first aid in, 263 
Insect stings, 265 
Itch, 267 
Ivy poison, 266 

Jaundice in new-born, 160 

Kicking of unborn baby, 28 
Kidneys, duties in pregnancy, 
26, 55 
harm from neglect, 76 
special care in pregnancy, 65- 
67, 78 
Knitted band, 105 
Kissing baby, 185 

Labor, 112 

pains, 109. 125 
preparations, 110 



stages, 112, 114, 115 
without doctor, 119 
(see also confinement) 
Lacerations from childbirth, 

116 
Laws for pregnant women em- 
ployed, 73 
protecting eyes at birth, 170 
Laxative diet in pregnancy, 45, 
62 
children's, 257-259 
Laxatives, 46, 64, 135, 159, 259 
Layette, 104-108 
Legs, swelling, 54, 58 

varicose veins, 78 
Length, fetus, 27 
baby's, 187 
children's, 239-240 
Leucorrhea, 15, 276 

(see also vaginal discharge) 
Lice, 268 
Life, feeling first signs, 28 

when not felt for some time, 
37 
Limbs, appearance of in baby, 
196 
swelling, 54, 58, 78 
Liquids (see diet, milk and 

water) 
Liver, at birth, 195 
Lochia, 128 

Lock-jaw, preventing, 263 
Longings in pregnancy, 47 
Loose bowels (see diarrhea) 
Lungs, in pregnancy, 26, 62 
(see also air, breathing, cry- 
ing and excretory organs) 
Lying-in period (see puerper- 
ium) 

Male cell, 18 

Malnutrition in pregnancy af- 
fecting child, 28, 48 
in children of pre-school age, 

205-214 
(see also health and diet) 

Mammary glands (see breasts) 

Massage, general, 68 
of breasts, 80 

Masturbation, 275 

Maternal impressions, 89-94 

Maternity corsets, 69 

Menopause, 13, 33 

Meals, planning, 249-252 
children's lunches, 251 
variety, 2 49 

Meat for children. 243 
in pregnancy, 48 

Meconium, first bowel move- 
ments, 14S 

Menstruation, 13. 15, 17 

return of after childbirth, 141 
stopping as sign of pregnancy, 
S3 

Mental diversion in pregnancy 
74 



284 



INDEX 



Milk certified, 159 
cow's, 156 

for children, 243 

daily quantity for child, 213 

too rich for child, 214, 261 

formulas for feeding, 157 

from breast, 152-156 

increasing quantity and 
strength, 138, 139 

pasteurized, 159 

(see also artificial feeding, 
breast-milk and food) 
Milk-crust, 190 
Milk-teeth (see teeth) 
Mind, development in baby, 192 

affect on pregnancy, 92-94 

overuse of in child, 207 
Miscarriage, causes, 55, 74, 82, 
83 

habitual, 83 

treatment, 85 

warning symptoms, 84 
Moral training, child's, 275 
Morning sickness, 35 

mind's influence on, 52 
Mother-cake, 34 

(see also placenta) 
Mother's marks (see birth- 
marks) 
Mouth, acid in pregnancy, 76, 
77 

treatment of baby's, 178 

child's, 225 

hand in, 272 
Moufh-breathing, 232 
Muscles, baby's, 197 

keeping up strength and tone 
for time of labor, 28, 73 

child's, 206 

Nails, baby's, 174 

children's, 222 
Nausea in morning sickness, 35, 

50-61 
Navel and cord, 24, 29 

around neck at birth, 121 

dressing, 146, 162 

dropping off, 195 

infection, 162 

tying at birth, 115, 120 
Neglected age, 205 
Nervous child, 207 
Nervous diseases from infected 

teeth, 224 ' 
Nervous system, after delivery, 
127 

baby's, 180, 197, 198 

child's, 236 

connection between mother's 
and child's, 92 

in bad habits, 275, 278 

nervous and forward child, 
236 
Night-clothes, 234 

night belt, 70 



Nipples, changes in, 35 

care of, 75 

cracked, 79 

retracted, 80 

position of in nursing, 152 

regulating flow from, 152 
Nose, care of in new-born, 177 

picking at (see worms) 

right way to blow, 268 
Nursery, 183 
Nursing, amount of milk, 154 

first day of, 151 

intervals, table of, 155 

length of time for, 153 

painful, 137 

position in, 152 (see also il- 
lustration) 

preventing sore nipples In, 79 

prolonged, 142 

regularity, importance of, 153 

rules, 151-156 

to contract uterus, 151 

weighing baby after, 153 
Nuts, in nursing mother's diet. 
139 

Obstetrical outfit, 97-103 
Oils, as cathartic, 47, 64 

for food, 64 

for burns, 264 

for massage, 68 

after swallowing acid, 263 
Open-air schools, 229 
Operation for tubal pregnancy, 

Ophthalmia of new-born, 143, 

169, 176 
Out-door life in pregnancy, 54 

for baby, 172 

for sickly children, 229 
Ovary, 12 

operation for removal, 33 
Ovum, 12, 89 

Pain in back, 17, 67, 69, 85 
Pains, labor, 109, 112, 125 

(see also confinement) 
Perineum, inspecting for tears, 

116 
Perspiration after childbirth, 

126 
Pessary, 141 

Physician, attention to special 
organs in pregnancy, 78 
cases in which to call at once, 
40, 55, 85, 110, 130, 163, 
171, 196 
consultation if pregnant, 34 
duties before and after child- 
birth, 103, 112, 140 
examinations by, in pregnancy 
and after confinement, 36, 
65, 82, 103, 112, 140 
sterilizing hands and instru- 
ments for childbirth, 100, 
101 



INDEX 



285 



Piles (see hemorrhoids) 

Pinworms, 272 

Placenta, formation of, 21, 24 

expelling, 116, 121 

piece retained, 128 
Play, child's, 210 
Poisoning, food, 262 

from bowels, 230 

in pregnancy from teeth, 76 
Poison Ivy, 266 
Poisons, swallowing, 262 
Poisons of pregnancy, 53-61 

(see also toxemias) 
Pregnancy (see table of con- 
tents) 
Pregnancy streaks, 68 
Premature birth, 86-88 
Pre-natal influence, 89-94 
Pressure of uterus, 77, 109, 113 
Puerperium or period after la- 
bor, 125-142 
Pulse in new-born, 150 

mother's after delivery, 126 
Pus in urine, 67 

Quickening, a positive sign of 
pregnancy, 36, 38 

Hash, 26'5 

Reaching-up, 73 

Rectum, giving medicine by, 59- 

61 
Reproduction, story of, 11 
Resuscitation of baby at birth, 

122 
Rest, baby's, 147, 181 

children's, 231 

in pregnancy, 92-94 

mother's, 118, 127, 132 

nervous child, 232 
Retention of urine, 135 
Rigg's disease, 224 
Rheumatism from decayed 

teeth, 224 
Rocking the baby, 181 
Room for confinement, 102 
Round shoulders, exercises, 234 
Round-worms, 272 
t Rupture (see hernia) 

Saliva, use in digesting starch 
in baby, 159 

Scales, baby, 154 

Scalp, new-born, 190 

School-child, health, 218 
diet, 241 

School lunches, 251 

Schools, open air, 229 

Senses, development of in babv, 
190-194 

Settling, 29, 36 

Sewing-machine, use of in preg- 
nancy, 83 

Sex, influencing, 30 



Shoes, baby's, 176 

mother's, 69 
Shock, stopping menstruation, 34 

causing premature birth, 88 
Shortness of breath in preg- 
nancy, 77 
Sickness in pregnancy, 50 
Signs of pregnancy, 32 
Sitz bath, 79, 81 
Skin, baby's, appearance of, 193 

baby's, care of, 148, 179 

changes during pregnancy, 68 

children's, care of, 220 

in pregnancy, care of, 67 

of buttocks when sore, 175 

new-born, 148 

(see also sweat glands) 
Sleep, baby's, 147, 181 

children's, 231 

disturbed by coffee, 139 

in pregnancy, 92-94 

mother's, 118, 127, 132 

nervous child's, 232 

Twilight, 124 
Sleeping-room, amount of fresh 

air in, 227-229 
Soft-spot (see fontanels) 
Speech, development of, 192 
Spermatazoon, 15 
Spine, new-born baby's, 194 
Sterility, causes of, 15, 91, 278 
Sterilizing, importance of, 9 5 

methods of, 96, 98, 99 

wounds 263 
Sties, 271 
Still-birth, 90 
Stools (see bowels) 
Summer complaint, conditions 

causing, 259 
Supplies for confinement, 97- 

103 
Supporter, abdominal, 122, 134 
Suppositories for hemorrhoids, 

79 
Sweat glands in pregnancy, 49, 
54 

in baby, 193 
Sweets, dangers from to chil- 
dren, 224, 248 
Swelling of face, 54, 58 

feet and limbs, 54, 58, 7S 
Swimming, effect on child, 2 21 
Syringe, in enema, 61 

fountain, 102 

to irrigate ear, 269 

Tape-worms, 272 
Tea, in pregnancy, 4 5 
after childbirth, 139 

Tears (see lacerations) 
Teeth, care of baby's. ITS 
care of children's. 222 
care of mother's, 18 4 
decay in pregnancy, 76, 7 7 
eruption of milk teeth. 199 



286 



INDEX 



eruption of permanent teeth, 
226, 227 

examinations of, 225 

straightening, 225 

pulling temporary, 225 
Teething, 199 
Temperature, baby's, 150 

after delivery, 126, 129 

mother's, 129 
Thermometer, clinical, 129, 150 
Thumb-sucking, 272 
Tonsils, 223, 225, 232 

infecting ear, 268 
Toxemias of pregnancy, 51 
Toys, 185 

Tubal pregnancy, 40 x 
Tuberculosis of mother in preg- 
nancy, 26, 88, 91 
Tumors causing sterility, 19 
Twilight sleep, 124 
Twins, 13, 30, 39 
Twitching muscles as sign of 
toxemia, 54 

Umbilical cord (see navel) 
Urination, disturbance of dur- 
ing pregnancy, 36 
Urination, control of, in chil- 
dren, 180, 198 

disturbance of during preg- 
nancy, 36 

failure after childbirth, 135 

frequent, 36 
Urine, albumin in, 55 

baby's, 180, 198, 149 

collecting specimen, 65, 66 

examination, 55, 65, 78 

in new-born, 149 

pus in, 67 
Uterus (see womb) 

Vagina, 11, 112 

packing, in hemorrhage, 130 
Vaginal discharge, 15, 80, 81, 

110, 128, 276 
Varicose veins, 78 
Vegetables, value in diet, 246 
Vegetarian diet in pregnancy, 

48 
Veins, swollen, 77, 78 
Ventilation, necessity for in 

sleeping and living rooms, 

71, 72, 227 
Vernix caseosa, 145 



Villi, 22, 40 

Vision, disturbance of in preg- 
nancy, 54 
(see also eyes) 
Vomiting, morning sickness, 35, 
50-61 
persistent, 35, 52 
how to cause, in child, 262 
Vulva, abrasions and cleansing 
after childbirth, 131 

"Walk, learning to, 197 
Water, for baby, 151, 159 

drinking to carry off poisons, 

231 
during pregnancy, 36, 45, 54 
"Weaning, immediate, 138 
Weight, baby's table of, 148, 
187 
children's table of, 239-240 
expectant mother's, 42 
following delivery, 127 
Wetting the bed, 271 
Womb, anatomy, 14 

displacements, 17, 82, 132. 

140 
enlargement due to preg- 
nancy, 36 
enlargement from tumors, 36 
dilation during labor, 113 
inflammation, 82 
inserting pessary for dis- 
placement, 141 
lining of, 19 
position at different months 

of pregnancy, 29 
restoration, after childbirth, 
140 
Worms, 272, 276 

restlessness, a sign of, 232 
Work during pregnancy, effect 

on baby, 28, 39, 49, 73 
Worry, effect on baby, 92-94 
effect on morning sickness, 

52 
effect on children, 236 

X-ray photographs of teeth, in 
pregnancy, 76 
of roots of teeth in children, 

225 

Yeast, for boils, 265 




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